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

Berti, Sérgio; Pastormerlo, Luigi Emilio; Korsholm, Kasper; Saw, Jacqueline; Alkhouli, Mohamad; Costa, Marco; Odenstedt, Jacob; Packer, Erik; Tondo, Claudio; Santoro, Gennaro; Nielsen‐Kudsk, Jens Erik

doi:10.1002/ccd.29791

Cited by 21 publications

(22 citation statements)

References 31 publications

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“…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.…”

Section: Is Preprocedural Ct Truplan‐based Reasonably Enough?mentioning

confidence: 94%

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

Tondo

2022

Cardiovasc electrophysiol

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There is still uncertainity about the use of computed tomography-scan for left atrial appendage occlusion (LAAO) device sizing. The main reason for this disappointing position is likely to relate to the scarcity of robust data, since there is still difference among institutions with regards how to perform measurement of the devices. Dallan et al. report their own experience on the use of a novel computed tomography angiography-based (CTA) for sizing the Watchman Flex device for LAAO. The authors through the TruPlan software package that a preprocedural CTA sizing protocol can be applied successfully with intracardiac echocardiography guidance and provide excellent procedural outcomes. The applied CTA protocol is safe and can provide high success rates with the WatchmanTM FLX device reducing the number of deployment attempts and reducing the risk of complications.

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Section: Is Preprocedural Ct Truplan‐based Reasonably Enough?mentioning

confidence: 94%

“…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…”

Section: Is Preprocedural Ct Truplan-based Reasonably Enough?mentioning

confidence: 99%

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

Tondo

2022

Cardiovasc electrophysiol

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“…(B) Fluoroscopic anteroposterior view to cross the IAS puncture site with a hydrophilic floppy Terumo wire. (C) After exchanging the floppy guidewire for an Amplatz stiff guidewire, a 65‐cm‐long 10F Arrow sheath is advanced over the stiff guidewire into the LUPV 4 . Finally, the ICE probe can be advanced directly into the LUPV.…”

Section: Methodsmentioning

confidence: 99%

Facilitation techniques to cross the interatrial septum with intracardiac echocardiography during left atrial appendage closure

Vanhaverbeke

Nuyens

Bieliauskas

et al. 2022

Cathet Cardio Intervent

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Objectives This study aimed to assess the rate of difficult interatrial septum (IAS) crossing with the intracardiac echocardiography (ICE) probe during percutaneous left atrial appendage (LAA) closure and to identify techniques that facilitate IAS crossing with the ICE probe. Background Percutaneous LAA closure is increasingly performed by ICE guidance. Although such an approach omits the need for general anesthesia, crossing of the IAS with the ICE probe may sometimes be challenging. Methods All consecutive patients that underwent ICE‐guided percutaneous LAA closure with an Amplatzer Amulet (Abbott) or WatchmanFLX (Boston Scientific) at our center in the period 2018–2021 were included. Cases in which IAS crossing with ICE was difficult were identified and techniques used to facilitate IAS crossing were identified and listed. Results In 17 (5%) out of 354 cases, IAS crossing with the ICE probe was difficult and required use of additional techniques. Ultimately, IAS crossing was also successful in these 17 cases by using one of three possible facilitation techniques: the probing technique (12 cases), the double‐wire technique (3 cases), and the snaring technique (2 cases). In one case, the double‐wire technique was converted to the snaring technique, as crossing of the ICE probe remained challenging despite the use of two stiff guidewires. Conclusion Crossing of the IAS with the ICE probe can be challenging in 5% of ICE‐guided percutaneous LAA closure procedures. Operators should be aware of possible facilitation techniques in challenging cases, as these show to be safe and effective.

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“…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.…”

Section: Ice Versus Tee Guided Laacmentioning

confidence: 99%

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

Chen

et al. 2022

Journal of Cardiac Surgery

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Left atrial appendage closure (LAAC) is an effective means of preventing ischemic stroke in patients with nonvalvular atrial fibrillation. Transesophageal echocardiography (TEE) is the primary imaging technique to guide LAAC. Its shortcomings, namely the use of general anesthesia and tracheal intubation, inevitably increase procedural risks. Intracardiac echocardiography (ICE), a novel imaging modality for guiding LAAC, has proven more advantageous over TEE due to use of local anesthesia, shortened procedural time, and reduced radiation exposure. This review highlights the differences between ICE and TEE guided LAAC, aiming to provide a reference for clinical decision-making.

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

Cited by 21 publications

References 31 publications

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

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

Facilitation techniques to cross the interatrial septum with intracardiac echocardiography during left atrial appendage closure

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

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