Safety and efficacy of left atrial appendage occlusion guided by CT-scan and intracardiac echocardiography from the left atrium

Objectives We compare the efficacy and safety of intracardiac echocardiography (ICE) from the left atrium (LA) with transesophageal echocardiography (TEE) for procedural guidance of transcatheter left atrial appendage occlusion (LAAO). Background Few data are available about the safety and efficacy of the use of ICE from the LA to guide LAAO procedure in local anesthesia. Methods A single-center, cohort study of patients undergoing LAAO with the Amplatzer Cardiac Plug or Amulet (St. Jude Medical, St. Paul, Minnesota). Procedures were guided by ICE from the LA with local anesthesia (n = 42) or TEE using general anesthesia (n = 48). A total of 80 (89%) patients had preprocedural cardiac computed tomography. Efficacy outcomes were technical success, procedural success, and peridevice leakage at 6 weeks after LAAO. Safety outcome was a composite of periprocedural complications. Results Technical success was achieved in 98% of both the TEE and ICE group. Procedural success was similar between groups: 95% success rate in the TEE-guided group, and 96% in the ICE-guided group. Major periprocedural complications occurred in 4% of the TEE group and 2% of the ICE group. Rate and degree of peridevice leak did not differ between groups at follow-up. Turnover time in the catheter laboratory, and contrast use were reduced with ICE. Conclusions ICE in the left atrium to guide LAAO procedures as compared with TEE appears to be effective and safe, without increased procedure-related complications. Similar procedural rate can be obtained with ICE despite decrease time procedure and local anesthesia.