Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Abstract

Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) are sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. We aim to evaluate the clinical outcomes and safety of ICE-guided LAAC within a zerofluoroscopy catheter ablation procedure.Methods and Results: From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC were achieved in all patients.Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 75.0% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA 2 DS 2 -VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

A comparable efficacy and safety between intracardiac echocardiography and transesophageal echocardiography for percutaneous left atrial appendage occlusion

“…This meta-analysis includes 20 studies with a total of 3,610 AF patients (1,564 patients for ICE and 2,046 patients for TEE) consisting of 10 observational two-arm studies (965 ICE patients and 2,046 TEE patients) [6][7][8][9][10][11][12][13][14][15] and 10 single-arm studies (599 ICE patients) [16][17][18][19][20][21][22][23][24][25] . The selection flowchart was displayed in Figure 1 .…”

“…Among the included clinical studies, the mean CHA2DS2-VASc score and HAS-BLED score ranged from 3.9 to 5.3 and 2.4 to 4.4. Eleven studies included Watchman or Watchman FLX [6,8,9,13,16,17,[19][20][21][22][23] , six included the ACP or Amulet device [10,11,14,18,24,25] and three studies included both [7,12,14] . The baseline characteristics and procedure-related indexes of the eligible studies were presented in Table 1 .…”

Left atrial appendage closure for stroke prevention in atrial fibrillation patients: A promise that came true

“…Intracardiac echocardiography (ICE) has increasingly been utilized as a novel imaging modality for guiding LAAC in recent years, which is regarded to be more advantageous over TEE due to the avoidance of general anesthesia. The safety and efficacy of ICE-guided approach have been explored by a number of small studies, [30][31][32] In addition, the fusion imaging (FI) of transesophageal echocardiography and X-ray performed during the procedure is in principle available and in practice by some operators, 33 albeit limited experience and the lack of data showing a clinical benefit of this technology have slowed its advancement.…”

“…Intracardiac echocardiography (ICE) has increasingly been utilized as a novel imaging modality for guiding LAAC in recent years, which is regarded to be more advantageous over TEE due to the avoidance of general anesthesia. The safety and efficacy of ICE‐guided approach have been explored by a number of small studies, 30–32 nevertheless, further evidence in larger cohorts are necessitated to confirm these findings. There is lack of a standardized imaging protocol as well, which have slowed the adoption of ICE‐guidance into clinical LAAC practice.…”

Functional assessment of left atrium by echocardiography after radiofrequency ablation of pulmonary vein ostia and left atrium at patients with surgical treatment of atrial fibrillation and mitral valve replacement

“…Современные возможности эхокардиографии (ЭхоКГ) и широта использования магнитно-резонансной томографии (МРТ) позволила на сегодняшний день изучить транспортную функцию ЛП при помощи оценки параметров продольной дефор мации (strain, %) и величины скорости деформации (c-1, strain rate), а также оценки систоли ческой и диастолической функций на ос-новании объемных показателей ЛП по данным ЭxоКГ и чрес пищеводной ЭхоКГ (ЧПЭхоКГ) [5,21].…”