Single trans‐septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure

Aguirre, Daniel; Pincetti, Christian; Pérez, Luis Alberto Santos; Deck, Carlos; Alfaro, Mario; Vergara, María Jesús; Maluenda, Gabriel

doi:10.1002/ccd.27246

Cited by 16 publications

(21 citation statements)

References 20 publications

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“…Transoesophageal echocardiography (TOE) is currently the gold standard imaging modality for the guidance of LAAO . However, intracardiac echocardiography (ICE) is now being used to guide a multitude of percutaneous interventions for structural heart disease and its utility in guiding percutaneous LAAO has been suggested by several studies …”

Section: Introductionmentioning

confidence: 99%

Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta‐analysis

et al. 2019

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Aims We performed a meta‐analysis to compare the safety and efficacy of intracardiac echocardiography (ICE) vs transoesophageal echocardiography (TOE) for the guidance of percutaneous left atrial appendage occlusion (LAAO). Methods and Results A comprehensive search of the literature was performed, from inception to December 2018 using MEDLINE, Cochrane Library, and Google Scholar electronic databases, and references from articles. Publications comparing ICE and TOE for the guidance of percutaneous LAAO were included in the analysis. The co‐primary endpoints were procedural success and procedure‐related complications. Secondary endpoints included procedural and fluoroscopy times and the volume of contrast media used. Five studies were included in the analysis, providing a total of 1122 patients. Procedural success was similar with both techniques (pooled odd ratio [OR] 1.46, 95% confidence interval [CI] 0.77–2.75, P = 0.24, I2 = 0%), with a trend for less procedure‐related complications in the ICE group (pooled OR 0.57, 95% CI 0.31–1.05, P = 0.07, I2 = 0%). Neither procedural (mean difference −1.64 minutes, 95% CI −16.42 to 13.14, P = 0.83, I2 = 96%) nor fluoroscopy times (mean difference + 1.29 minutes, 95% CI −1.38 to 3.97, P = 0.34, I2 = 76%) varied significantly between groups. There was a reduction in the volume of contrast media used in the ICE group (mean difference −9.71 mL, 95% CI −14.61 to −4.81, P > 0.01, I2 = 0%). Conclusion Intracardiac echocardiography is a safe and effective alternative to TOE for guidance of percutaneous LAAO.

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Section: Introductionmentioning

confidence: 99%

Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta‐analysis

et al. 2019

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“…No heterogeneity or publication bias was found. In the 15 eligible studies, the technical success rates, which were not estimated, between the ICE and TEE groups were equal to 100% in 7 studies (Aguirre et al, 2018;Berti et al, 2018;Clemente et al, 2015;Frangieh et al, 2017;Hemam et al, 2019;Ho et al, 2007;Matsuo et al, 2016). The pooled effects were driven by the remaining 8 studies (Berti et al, 2014;Frikha et al, 2016;Iwasawa et al, 2016;Kim et al, 2018;Korsholm et al, 2017;Masson et al, 2015;Naim et al, 2015;Reis et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…The baseline information of the included studies is reported in Table 1. Patients were mainly from Europe (7 studies) (Berti et al, 2014(Berti et al, , 2018Clemente et al, 2015;Frangieh et al, 2017;Korsholm et al, 2017;Matsuo et al, 2016;Reis et al, 2018), the Asia-Pacific region and the US (8 studies) (Aguirre et al, 2018;Frikha et al, 2016;Hemam et al, 2019;Ho et al, 2007;Iwasawa et al, 2016;Kim et al, 2018;Masson et al, 2015;Naim et al, 2015). There were 827 patients in the ICE group and 1236 patients in the TEE group.…”

Section: Study and Characteristicsmentioning

confidence: 99%

“…Using intracardiac echocardiography (ICE) to guide LAAO, which only requires conscious sedation, may have potential advantages over TEE. Although some studies (Aguirre et al, 2018;Frangieh et al, 2017;Hemam et al, 2019;Ho et al, 2007;Masson et al, 2015;Matsuo et al, 2016) with small sam-ples of patients demonstrated that the feasibility and efficacy of ICE-guided LAAO were not inferior to those of TEE, the findings remain inconsistent, and few meta-analyses have assessed the results. Therefore, we sought to systematically evaluate the extent to which ICE is an alternative to TEE.…”

Section: Introductionmentioning

confidence: 99%

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Imaging with intracardiac echocardiography compared to transesophageal echocardiography during left atrial appendage occlusion

Liang

Wang

et al. 2020

Rev. Cardiovasc. Med.

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We performed a meta-analysis comparing the procedural and outcomes data and related to left atrial appendage occlusion guided by intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) in nonvalvular atrial fibrillation patients. Technical success with ICE was significantly similar to that of TEE (odds ratio [OR] 1.38, 95% CI [0.62, 3.09], I 2 = 0%, P = 0.43). The peri-procedural complications showed no significant difference between the two groups (OR 0.84, 95% CI [0.57, 1.23], I 2 = 0%, P = 0.37). Mortality was similar in procedures using ICE vs TEE (OR 0.89, 95% CI [0.51, 1.57], I 2 = 0%, P = 0.69). Landing zones, procedural time and fluoroscopic times between ICE and TEE showed no significant differences (MD 1.96, 95% CI [−0.01, 3.94], I 2 = 90%, P = 0.05; MD −1.64, 95% CI [−13.45, 10.17], I 2 =95%, P = 0.79; and MD 0.49, 95% CI [−2.18, 3.16], I 2 = 87%, P = 0.72, respectively). Imaging with ICE or TEE is associated with similar outcomes in left atrial appendage occlusion procedures.

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“…Aguirre et al describe left atrial appendage occlusion (LAAO) using the Amulet device with fluoroscopic and intra‐cardiac echo (ICE) imaging for guidance . They add the novel technical simplification of utilizing a single transseptal puncture to introduce both the ICE catheter along with the LAAO delivery catheter directly into the LA, rather than using two separate transseptal punctures.…”

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confidence: 99%

Intra‐cardiac echo for left atrial appendage occlusion

Feldman

Nazari

2018

Cathet Cardio Intervent

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Left atrial appendage occlusion using the Amulet device can be accomplished with fluoroscopic and intra-cardiac echo (ICE) imaging for guidance, obviating the need for general anesthesia and trans-esophageal echo. The ICE device can be placed directly into the left atrium, parallel to the occluder delivery system, using a single transseptal puncture, rather than via double transseptal puncture. The ideal methods for left atrial appendage imaging and procedure guidance have yet to be defined. The utility of CT evaluation is increasingly recognized. The emergence of three-dimensional ICE is likely to further our progress along the path of simplifying the LAAO procedure.

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Single trans‐septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure

Abstract: This initial experience suggests that LAA occlusion with the Amplatzer Amulet device using ICE guidance from the left atrium via a single trans-septal technique is feasible and safe.

Cited by 16 publications

References 20 publications

Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta‐analysis

Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta‐analysis

Imaging with intracardiac echocardiography compared to transesophageal echocardiography during left atrial appendage occlusion

Intra‐cardiac echo for left atrial appendage occlusion

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