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ICE-TEE safe, feasible for guiding LAA closure without general anesthesia
Use of an intracardiac echocardiography probe through the esophageal route was safe and feasible for the monitoring of left atrial appendage closure without general anesthesia, researchers reported in EuroIntervention.
The study included 16 patients with atrial fibrillation (mean CHADS-VASc score, 5; mean HAS-BLED score, 4) who had a relative contraindication to treatment with vitamin K antagonists and were referred for left atrial appendage (LAA) closure with the Amplatzer Cardiac Plug device (St. Jude Medical) between November 2011 and December 2012.
Before the procedure, all patients underwent standard transesophageal echocardiography (TEE) to determine the presence of a patent foramen ovale and rule out LAA thrombus. During the procedure, investigators used intracardiac transesophageal echocardiography (ICE-TEE) under local anesthesia to establish LAA size and track device positioning.
With standard TEE, the average minimum appendage diameter was 18 ± 1 mm for the TEE view between 35° and 55°, and the average maximum appendage diameter was 21 ± 3 mm for the TEE view between 55° and 90°. Increases in eccentricity index, defined as maximum over minimum LAA size ratio, correlated with increases in LAA diameter (P = .001). A strong correlation was found between maximum LAA size achieved with periprocedural ICE-TEE and that acquired with standard TEE measurement (P < .0001).
LAA closure was deemed successful in 15 patients, without complications.
The average implanted Amplatzer Cardiac Plug size was 25 ± 3 mm and was in agreement with the size predicted by ICE-TEE (r = 0.89) and standard TEE (r = 0.57). The researchers also reported a correlation between procedure duration (62 ± 27 minutes) and LAA size by ICE-TEE (P = .002) and eccentricity index (P = .02).
“[TEE] is generally used for the monitoring of [LAA] closure. A general anesthesia with mechanical ventilation is required to avoid discomfort,” the researchers wrote. “However, early diagnosis of neurological complications is challenging in sedated patients. This study demonstrates that an intracardiac echocardiography used through the esophageal route without sedation may be used for the monitoring of LAA closure with an [Amplatzer Cardiac Plug] device.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.