Outcomes of Routine Intracardiac Echocardiography to Guide Left Atrial Appendage Occlusion

Alkhouli, Mohamad; Chaker, Zakeih; Alqahtani, Fahad; Raslan, Saleem; Raybuck, Bryan

doi:10.1016/j.jacep.2019.11.014

Cited by 66 publications

(90 citation statements)

References 12 publications

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“…19,20 In most studies, the ICE probe is placed at one or two positions in the left atrium. 9,10,21 In some of these studies, the probe was placed only at the entrance of the LSPV. 9,21 Hemam et al 22 imaged the LAA from four different locations to evaluate the LAA and device, including the central LA body, deeper into the LSPV and LIPV, and transmitral.…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Wang

Zhou

et al. 2021

Preprint

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Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) is 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. To evaluate the clinical outcomes and safety of ICE guided LAAC within a zero-fluoroscopy 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 was achieved in all patients. Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 77.8% 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 CHA2DS2-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 a 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.

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Section: Discussionmentioning

confidence: 99%

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

Chen

Wang

Zhou

et al. 2021

Preprint

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“…Would this change with the emergence of novel (and potentially safer) devices and the wider adoption of minimalistic procedural techniques in the future? 8 4. Are these data generalizable to the global populations?…”

Section: Was the Increasing Use Of Doacs In Thismentioning

confidence: 99%

Stroke Prevention in Very Elderly Patients With Nonvalvular Atrial Fibrillation Revisited

Alkhouli

2021

Mayo Clinic Proceedings

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“… 18 There is also a growing interest in intracardiac echocardiography (ICE) to guide LAAC without the need for general anesthesia. 19 In addition, ICE mitigates the need for aerosolized procedures (ie, TEE); this strategy may become routine in guiding future LAAC in the post–coronavirus disease 2019 era. The anticipated future improvement in ICE catheter designs (eg, adding three-dimensional and x-plane capabilities) will further facilitate the growth of these trends.…”

Section: Procedures Invasiveness/workflowmentioning

confidence: 99%

Remaining Challenges With Transcatheter Left Atrial Appendage Closure

Alkhouli

Holmes

2020

Mayo Clinic Proceedings

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Outcomes of Routine Intracardiac Echocardiography to Guide Left Atrial Appendage Occlusion

Cited by 66 publications

References 12 publications

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

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

Stroke Prevention in Very Elderly Patients With Nonvalvular Atrial Fibrillation Revisited

Remaining Challenges With Transcatheter Left Atrial Appendage Closure

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