LEFT ATRIAL APPENDAGE OCCLUSION GUIDED BY INTRACARDIAC ECHOCARDIOGRAPHY - SINGLE CENTRE EXPERIENCE

Aims: Intracardiac echocardiography (ICE) has been proposed as an alternative to transoesophageal echocardiography (TOE) for periprocedural guidance of percutaneous left atrial appendage occlusion (LAAO). Our aim was to analyse feasibility, efficacy and safety of transcatheter LAAO guided by ICE.

Methods and results: We retrospectively evaluated 153 patients (age: 72 ± 8 years, 72% males) who underwent LAAO in our centre. Initial procedures were guided by TOE using general anaesthesia (n=7), then followed by ICE guidance from within the left atrium with only local anaesthesia (n=146). Mean CHA2DS2VASc and HAS-BLED scores were 4.1 ± 1.4 and 4.2 ± 1, respectively. Implanted devices were Amulet (n=124, 81%) and LAmbre (n=26, 17%) with a mean procedural time of 53 ± 21 minutes. The dominant indication for the LAAO was a history of bleeding (n=118, 77.1%), with the majority to gastrointestinal tract (n=57, 37.3%) and to the central nervous system (n=31, 20.3%). Three cases were procedural failures resulting in the technical success rate of 98%. Major advert cardiac events were reported in 11 cases (7.2%), including 1 post-procedural death due to acute heart failure in elderly patient within 24 hours (0.7%), 2 occluder dislocations treated surgically (1.3%), 3 pericardial effusions (2%, of which 2 required pericardiocentesis). After the procedure 124 patients (81%) were free of oral anticoagulant therapy. TOE at 3 and/or 6 months was available in 126 patients (82.4%) and device-related thrombosis was identified in 8 cases (6.3%). No significant peridevice leaks were observed.

Conclusions: ICE imaging from within the left atrium for LAAO eliminates the need of periprocedural TOE and GA and is associated with a high success rate and acceptable risk of complications. In addition, LAAO guided by ICE can be performed after a short learning curve.