Intracardiac Echocardiography Is Superior to Conventional Monitoring for Guiding Device Closure of Interatrial Communications

Abstract

Background— This study sought to test whether intracardiac echocardiography (ICE) is superior to conventional monitoring in guiding device closure of interatrial communications (atrial septal defect [ASD] and patent foramen ovale [PFO]). Methods and Results— Forty-four patients undergoing device closure of ASD (n=6) or PFO (n=38) were randomized to have the procedure guided by either ICE (group 1; n=22) or by transesophageal echocardiography (TEE) (group 2; n=22). All interventions were completed successfully. In 1 patient from group 2, atrial fibrillation occurred 1 day after device implantation; the patient was successfully cardioverted on the next day. There were no other complications. Fluoroscopy time (FT) (6.0±1.7 minutes versus 9.5±1.6 minutes; P <0.0001) as well as procedure time (PT) (33.4±4.7 minutes versus 37.8±5.6 minutes; P <0.01) were shorter in group 1 than in group 2. Group 2 patients required general anesthesia without (n=19) or with endotracheal intubation (n=3). In contrast, ICE allowed continuous monitoring of the whole procedure, including balloon sizing before device closure, without sedation. Conclusions— ICE is a safe tool to guide device closure of PFO and ASD. Supine patients tolerate ICE better than TEE. ICE reduces FT and PT. ICE seems to be advantageous, especially when long continuous or repeated echocardiographic viewing is required.

Intracardiac echocardiography: an ideal guiding tool for device closure of interatrial communications

“…They confirm and broaden the messages of previous investigations 7,9,10 showing the suitability of ICE to safely guide interventional therapy in interatrial communications. TEE requires general anesthesia with or without endotracheal intubation, whereas ICE permits unlimited echocardiographic viewing in fully conscious and compliant patients.…”

“…Two standardised views were used to get a sufficient overview of the complete defect including its rims and its spacial relation to the aorta and the superior vena cava as well as the right-sided pulmonary veins: longitudinal view showing the extent of the interatrial septum (IAS) from cranial to its distal margins and a perpendicular short-axis view to visualise the anterior part of the IAS and the transition to the ascending aorta. 7 Group 2 patients were sedated with 5 mg of midazolam and continuous intravenous administration of propofol at 5e10 mg/h. Patients who did not tolerate the probe under this regimen were intubated.…”

Incidence of thrombus formation on the CardioSEAL and the Amplatzer interatrial closure devices

“…Intracardiac echocardiographic imaging was used instead of TEE. 9 A transseptal puncture technique was used in 11 patients (17%) 10 because the PFO was long or there was a large atrial septal aneurysm.…”

Atrial Fibrillation and Atrial Septal Defect

“…It also helps in microbubble monitoring for power adjustment during radiofrequency ablation and in visualization of thrombus formation on catheters and sheaths. [126][127][128][129][130][131][132] In contrast to TEE though, it avoids esophageal probe insertion (and its associated risks), patient discomfort and general anesthesia.…”