Intracardiac echography for left atrial appendage closure: A step‐by‐step tutorial

Abstract

Objectives We sought to provide a practical educational tool for the utilization of intracardiac echography (ICE) in the left atrium for the percutaneous closure of the left atrial appendage (LAA). Background Although transesophageal echocardiography (TEE) is the gold‐standard imaging technique for LAA closure, ICE is stepping in to support noncoronary cardiology interventions by improving workflow and case turnover and may be more adequate for frail patients with significant and multiple comorbidities. Methods This article discusses the utility of ICE for LAA closure, its advantages compared to TEE, contraindications to TEE use and offers an extensive illustration of the main steps of the procedure. Conclusions The use of ICE in the left atrium allows a feasible guidance of all steps of the percutaneous closure of LAA.

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

“…A valid step by step tutorial on ICE use for left atrial appendage closure has been recently published 31 Video S13. shows LAA measurement by ICE.…”

“…A valid step by step tutorial on ICE use left atrial appendage closure has been recently published. 31 Video S13 shows LAA measurement by ICE. The integration of ICE in routine LAAO practice has been hindered by the limitations of the current technology and the lack of standardized work flow and imaging protocols.…”

4D Volume Intracardiac Echocardiography for Intraprocedural Guidance of Transcatheter Left Atrial Appendage Closure

“…The LAA and the WATCHMAN device were characterized from multiple viewing angles, akin to TEE, by methodically orienting the multiplanar images reconstructed from the volume images 23 . Every effort was made to obtain the equivalent views on the 4D volume ICE that correspond to the requisite angles 0°, 45°, 90°, and 135°.…”

Comparing Measurements of Intracardiac Echocardiography and Other Periprocedural Imaging of the Left Atrial Appendage For Percutaneous Occlusion

“…In the early years, Intracardiac echocardiography (ICE) was used to guide structural heart disease (such as atrial septal defect occlusion) and catheter ablation during electrophysiological surgery [6,7] . Because of its many advantages, such as local anesthesia, optimization of surgical procedure and early identification of complications, it has been used in LAAO as a feasible alternative to TEE in recent years [5,8,9] . Most of the previous studies put ICE in right atrium(RA) to measure LAA [10,11] .However, ICE may not be able to accurately measure the size of LAA from RA because of insufficient axis alignment and anatomical limitations.…”