1 Introduction
Transcatheter left atrial appendage closure (LAAC) has become a reasonable alternative to long term oral anticoagulant therapy (OAT) to prevent stroke in patients with non-valvular atrial fibrillation (NVAF)1. The procedure is predominantly guided by transesophageal echocardiography (TEE) under general anesthesia or deep sedation. In many centers in China, it is performed under local anesthesia instead. The occluder is first implanted with fluoroscopic guidance, and the TEE probe is then placed with local laryngeal anesthesia to assess the device position and residual peri-device leak before final device release. TEE examination is generally safe and widely used in LAAC procedure, but it remains limited by requirement of general anesthesia or deep sedation and small risk of severe esophageal complications. More importantly, TEE fails to optimally visualize left atrial appendage (LAA) structures and devices especially at long-axis view in some patients due to varied anatomical positions of the esophagus and the LAA. Intracardiac echocardiography (ICE) has been reported as an alternative to TEE for guiding LAAC2-6, however, the feasibility of achieving consistent multi-planar imaging quality remains unproven. Therefore, we aimed to investigate whether ICE could achieve comparable multi-angled views as TEE during LAAC.
Methods