Intracardiac Versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion

Berti, Sérgio; Pastormerlo, Luigi Emilio; Santoro, Gennaro; Brscic, Elvis; Montorfano, Matteo; Vignali, Luigi; Danna, Paolo; Tondo, Claudio; Rezzaghi, Marco; D’Amico, Gianpiero; Stabile, Amerigo; Saccà, Salvatore; Patti, Giuseppe; Rapacciuolo, Antonio; Poli, Arnaldo; Golino, Paolo; Magnavacchi, Paolo; Meucci, Francesco; Pezzulich, B.; Stolcova, Miroslava; Tarantini, Giuseppe

doi:10.1016/j.jcin.2018.05.008

Cited by 75 publications

(90 citation statements)

References 17 publications

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“…A total of 66 relevant citations were identified (Figure ). After a detailed evaluation of these studies, five studies ultimately met the inclusion criteria enrolling 1157 patients (TEE = 766 vs ICE = 391) …”

Section: Resultsmentioning

confidence: 99%

“…Based on the Cochrane risk bias assessment tool all the included studies were classified as low risk, high risk, and unclear risk as the included studies are nonrandomized and observational (Table ). Three studies were conducted in Europe, one in South Korea, and one in the United States ).…”

Section: Resultsmentioning

confidence: 99%

“…The mean age of the patients included in the studies ranged from 71.5 to 78.5 years (excluding the study by Iwasawa et al). Two studies included Watchman, two included the ACP/Amulet device, and one study included both . ACP/Amulet was the most commonly implanted LAAC device among the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…However, this can be potentially overcome by guiding ICE transseptally into the left atrium, pulmonary artery, or the left superior pulmonary vein. Among the studies included in this analysis, ICE catheter was placed in the left atrium in four studies and both right and left atrium in one …”

Section: Discussionmentioning

confidence: 99%

“…Recently, intracardiac echocardiography (ICE) has evolved as an alternative imaging modality for implantation of LAAC. However, there are limited studies comparing TEE vs ICE‐guided LAAC …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Intracardiac vs transesophageal echocardiography for percutaneous left atrial appendage occlusion: A meta‐analysis

Velagapudi

Turagam

Kolte

et al. 2019

Cardiovasc electrophysiol

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Introduction Percutaneous left atrial appendage closure (LAAC) is typically performed utilizing transesophageal echocardiography (TEE) and fluoroscopy. Intracardiac echocardiography (ICE) can be a suitable alternative to guide implantation. Given the limited data, we performed a meta‐analysis of all studies that compared ICE vs TEE for percutaneous LAAC. Methods A comprehensive literature search was performed in PubMed, Embase, Scopus, Google Scholar, and major scientific conference sessions for published abstracts and manuscripts until 1 August 2018. Studies reporting clinical outcomes comparing TEE vs ICE for endocardial LAAC in human subjects aged greater than or equal to 18 years were included. Two investigators independently extracted the data and individual quality assessment was performed. The analysis was performed using Cochrane Collaboration software, RevMan 5.3. Results Five eligible studies consisting of 1157 patients (ICE‐391 patients and TEE‐766 patients) were included. Four studies were retrospective and one was prospective, nonrandomized. Two studies included Watchman, two included the Amplatzer Cardiac Plug/Amulet device, and one included both devices. There was no significant difference in CHA2DS2VASC or HAS‐BLED scores between both groups. There was no significant difference in acute procedural success between ICE vs TEE (risk ratio, 1.01; 95% CI, 0.99‐1.04; P = 0.24). There was no significant difference in fluoroscopy time (mean difference [MD], 1.84 minutes; 95% CI, 0.59‐4.27; P = 0.14) and total procedure time (MD, −5.06 minutes; 95% CI, −24.6‐14.4; P = 0.61) between both groups. There was also no significant difference in complications including pericardial tamponade, device embolization, and stroke between both groups. Conclusion In our meta‐analysis, ICE was as effective as TEE during percutaneous LAAC.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Intracardiac vs transesophageal echocardiography for percutaneous left atrial appendage occlusion: A meta‐analysis

Velagapudi

Turagam

Kolte

et al. 2019

Cardiovasc electrophysiol

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

Berti

Pastormerlo

Korsholm

et al. 2021

Catheter Cardiovasc Interv

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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.

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In‐hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure

Morcos

Megaly

Saad

et al. 2022

Cathet Cardio Intervent

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Background: Transesophageal echocardiogram (TEE) is the preferred imaging modality to guide transcatheter left atrial appendage closure (LAAC). Intracardiac echocardiography (ICE) has evolved as a less invasive alternative to TEE. Several observational studies have shown similar success rates and perioperative complications between TEE and ICE for LAAC.Objectives: We sought to examine the temporal trends and patient characteristics of TEE versus ICE use in LAAC using a national database. We also evaluated hospital outcomes including periprocedural complications, mortality, and length of hospital stay.Methods: This is a retrospective analysis of data from the National Readmission Database, collected from 2016 to 2018. The primary outcome was major adverse events (MAE) defined as in-hospital mortality, cardiac arrest, pericardial effusion with or without tamponade, pericardiocentesis or window pericardiocentesis and pericardial window, pericardial effusion and tamponade, and hemorrhage requiring transfusion.Results: Trend analysis showed that TEE-guided LAAC increased from 96.6% in 2016 to 98.4% in 2018 (relative increase, 1.9%), while ICE-guided LAAC decreased from 3.4% to 1.6% during the same period (relative decrease, 53%, p for trend = 0.08). In the unmatched cohorts, the MAE was significantly lower in TEE-guided LAAC compared to ICE-guided LAAC (6.5% vs. 9.3%, p = 0.022). In the propensity score matching analysis, MAE remained significant (5.6% vs. 9.4%, p < 0.001). The incidence of pericardial effusion with or without tamponade remained significantly lower in the TEE group (2.3% vs. 5.8%, p < 0.001). Length of stay (3.4 vs. 1.9 days, p < 0.001) and hospitalization cost ($34,826 vs. $20,563, p < 0.001) remained significantly lower for TEE-guided LAAC.

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Intracardiac Versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion

Abstract: ICE-guided LAAO by means of Amplatzer devices may represent a second alternative imaging modality after an appropriate learning curve and bearing in mind that pre-procedural computed tomography imaging is mandatory. When comparing ICE with TEE, TEE remains the gold standard.

Cited by 75 publications

References 17 publications

Intracardiac vs transesophageal echocardiography for percutaneous left atrial appendage occlusion: A meta‐analysis

Intracardiac vs transesophageal echocardiography for percutaneous left atrial appendage occlusion: A meta‐analysis

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

In‐hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure

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