Intracardiac vs. Transesophageal Echocardiography for LAAO

Oct 16, 2023
Font Size
A
A
A
Authors:
Ferro EG, Alkhouli M, Nair DG, et al.
Citation:
Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S. JACC Clin Electrophysiol 2023;Oct 11:[Epublished].
Summary By:
Thomas C. Crawford, MD, FACC

Quick Takes

  • In a registry of Watchman FLX implantation for left atrial appendage occlusion, intracardiac echocardiography (ICE) and TEE patients had similar baseline characteristics and mean procedural times, but ICE patients were less likely to receive general anesthesia (54% vs. 98%, p < 0.01).
  • ICE- and TEE-facilitated device implantation was successful in 98% vs. 98% of patients and complete seal rates were similar (83% vs. 82%).
  • Pericardial effusion rates requiring intervention were significantly higher with ICE than TEE (1.0% vs. 0.5%, p = 0.02).

Study Questions:

What are the outcomes after intracardiac echocardiography (ICE)- versus transesophageal (TEE)-guided Watchman FLX implantation?

Methods:

The authors analyzed data in the SURPASS (SURveillance Post Approval AnalySiS Plan) nationwide left atrial appendage occlusion (LAAO) registry over a 1-year period starting in 2020.

Results:

LAAO was attempted in 39,759 patients at 698 sites. About 5.7% of the cases were done with ICE and 80% with TEE. ICE and TEE patients had similar baseline characteristics and mean procedural times. ICE patients were less likely to receive general anesthesia (54% vs. 98%, p < 0.01). Successful device implantation (98% vs. 98%) and complete seal rates at 45 days were similar (83% vs. 82%). Most adverse event rates were similar, including unadjusted and adjusted mortality rates at 45 days. Pericardial effusion rates requiring intervention were significantly higher with ICE than TEE (1.0% vs. 0.5%, p = 0.02). This rate decreased as operators performed more ICE-guided procedures, although 82% of operators had performed <10 ICE-guided procedures overall.

Conclusions:

The authors conclude that: 1) ICE use was infrequent, 2) both ICE and TEE achieved high rates of complete LAAO, and 3) ICE was associated with significantly higher rates of pericardial effusion requiring intervention.

Perspective:

The pivotal trials of the two currently approved LAAO devices were guided by intraprocedural TEEs. ICE offers an alternative imaging technique. Both TEE and ICE offer advantages and disadvantages. TEE usually requires general anesthesia and ICE requires another point of vascular access and a potential requirement for a second transeptal puncture. The authors demonstrate that the main outcomes measured were no different between the groups. While the initial reports of ICE use for LAAO closure were published about 15 years ago, they still account for only a small minority of the cases. Pericardial effusion rates requiring intervention were significantly higher with ICE than TEE. Most operators had performed <10 ICE-guided procedures overall. Future studies of the two approaches should rigorously evaluate outcomes with the two techniques.

Clinical Topics: Noninvasive Imaging, Pericardial Disease, Echocardiography/Ultrasound

Keywords: Atrial Appendage, Echocardiography, Transesophageal, Pericardial Effusion


< Back to Listings