Intracardiac echocardiography for guidance of transcatheter left atrial appendage occlusion: An expert consensus document

Abstract

Transcatheter left atrial appendage occlusion (LAAO) is an increasingly used alternative to oral anticoagulation in selected patients with atrial fibrillation. Intraprocedural imaging is a crucial for a successful intervention, with transesophageal echocardiography (TEE) as the current gold standard. Since some important limitations may affect TEE use, intracardiac echocardiography (ICE) is increasingly used as an alternative to TEE for guiding LAAO. The lack of a standardized imaging protocol has slowed the adoption of ICE into clinical practice. On the basis of current research and expert consensus, this paper provides a protocol for ICE support of left atrial appendage occlusion.

Seize the day, …s(e)ize the device: The emerging imaging modality to improve left atrial appendage device sizing

“…The use of ICE favors a smoother intraprocedural workflow, since general anesthesia is not required and the operator can easily maneuver the ICE probe with no need of the echo expert's assistance. In our own experience, LAA visualization and measurements, ruling out thrombus, device sizing and placement can effectively achieved through ICE and with an excellent outcome 9 . Also, with the advent of 3D ICE technology, 10 more reliable and adequate measurements is offered guiding to a successful and safe LAAO procedure.…”

“…In our own experience, LAA visualization and measurements, ruling out thrombus, device sizing and placement can effectively achieved through ICE and with an excellent outcome. 9 Also, with the advent of 3D ICE technology, 10…”

Can intracardiac echocardiography completely replace transesophageal echocardiography to guide left atrial appendage closure?—The comparisons of intracardiac echocardiography with transesophageal echocardiography

“…Currently, the consensus recommendation is usually to exclude LAA thrombus by TEE or CCTA before the LAAC procedure 36 . In view of the advantages of ICE compared with disadvantages of TEE, operators may consider to use ICE during procedure to verify LAA thrombus as an alternative to TEE and CCTA although ICE usually plays an auxiliary role to further exclude LAA thrombus intraoperatively.…”

Left Atrial Appendage Closure: A Current Overview Focused on Technical Aspects and Different Approaches

“…Intracardiac echocardiography (ICE) is an alternative technique to TEE for percutaneous LAAO [20,21].…”

“…This device exists in 5 different sizes (21,24,27,31,35) and is preassembled within a placement catheter (14 Fr). Two measures are essential to determine the correct device size: the "landing zone" measured from the circumflex coronary artery and the transition between smooth and trabecular atrial appendage, and the depth measured from the "landing zone" to the apex of the atrial appendage.…”