Intracardiac echocardiography for guidance of LAAO reduces time in cath lab

A recent study compared intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) for procedural guidance of left atrial appendage occlusions. Both approaches proved to be safe and effective, with no increase in procedure-related complications arising with ICE.

Led by Kasper Korsholm, with the department of cardiology at Aarhus University in Aarhus, Denmark, the study was published online August 30 in JACC: Cardiovascular Interventions.

While oral anticoagulants have been a standard therapy to prevent stroke in patients with atrial fibrillation, left atrial appendage occlusion (LAAO) has become a serious alternative for patients who cannot tolerate the anticoagulants. For LAAO to succeed, periprocedural visualization is essential.

“This [visualization] is typically performed with TEE under general anesthesia. However, alternative options have been pursued to facilitate logistics and avoid general anesthesia,” the authors wrote.

The aim of their study was to report on the immediate procedural and short-term efficiency and safety of LAAO with ICE guidance.

The study was a single-center, cohort study. There were 109 patients in the ICE group and 107 in the TEE group.  In 99 percent of both groups, technical success was achieved. Procedural success was achieved in 94.4 percent of the TEE patients and in 94.5 percent of the ICE patients. Major periprocedural complications occurred in 4.7 percent of the TEE group and in 1.8 percent of the ICE group. At follow-up, no differences emerged between groups in the rate of degree of peridevice leaks.

“Overall time spent in the catheter laboratory was significantly reduced with ICE guidance,” the authors wrote. They called for a multicenter randomized controlled trial and cost-effectiveness analysis to build on their work regarding ICE, a promising imaging modality.