Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman

Abstract

ICE guidance for LAAO with the Watchman device is feasible and comparable to TEE and may become the preferred imaging modality for LAAO. © 2016 Wiley Periodicals, Inc.

Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta‐analysis

“…Significant differences in procedural (mean difference −1.64 minutes, 95% CI −16.42 to 13.14, P = 0.83, I 2 = 96%) and fluoroscopy times (mean difference + 1.29 minutes, 95% CI −1.38 to 3.97, P = 0.34, I 2 = 76%) between groups were not noted, although significant heterogeneity among studies was observed. Only two studies compared the volume of contrast agent used in each group. The contrast agent volume was substantially smaller in the ICE group (mean difference −9.71 mL, 95% CI −14.61 to −4.81, P > 0.01, I 2 = 0%), but these results are mainly driven by the results of Korsholm et al , which had a weight of 94% in the analysis.…”

“…In initial reports of ICE‐guided LAAO, the ICE probe was positioned in the right heart . A later trend, however, was to advance the ICE probe into the left atrium (LA) to optimize LAA visualization . Potential disadvantages of advancing the ICE probe into the LA are the need for a second transseptal puncture or the creation of a larger ASD, when the occlusion device delivery system and the ICE probe are advanced through the same transseptal puncture.…”

“…7,8 However, intracardiac echocardiography (ICE) is now being used to guide a multitude of percutaneous interventions for structural heart disease 9 and its utility in guiding percutaneous LAAO has been suggested by several studies. [10][11][12][13][14][15][16][17][18] An ICE-guided approach obviates the need for general anesthesia or deep sedation during LAAO. This is a major advantage in such a setting, where patients are often fragile and have a high anesthetic risk.…”

“…This would be an interesting point for future research, as chronic kidney disease is common in the population targeted for LAAO. [11][12][13][14] Unfortunately, none of the studies included in the analysis compared renal outcomes between groups.…”

Role of Imaging in Left Atrial Appendage Occlusion

“…With a successful ICE-guided LAA closure reported rate ≥ 97%, ICE has proved to be a valid alternative imaging modality for LAA occlusion in experienced centers [56][57][58][59]. The main advantage of ICE utilization is that it avoids the need for general anaesthesia or deep sedation, which can be associated with additional complications (aspiration, delirium…), lead to longer procedure-time and to additional resource utilization.…”