Authors and affiliation
Fangyi Xiao MD1,2 †, Yanyan Chen MD3
†, Yat-Yin Lam MD4, Yihe Chen
MD1,2, Liangguo Wang MD1,2, Ying
Fang MD1,2, Lan Su MD1,2, Weijian
Huang MD1,2 *
- Department of Cardiology,
the
First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang,
Wenzhou 325000, P.R. China.
- the Key Lab of Cardiovascular Disease of Wenzhou, Nanbaixiang, Wenzhou
325000, P.R. China.
- Department
of Neurology, the First Affiliated Hospital of Wenzhou Medical
University, Nanbaixiang, Wenzhou 325000, P.R. China.
- Hong Kong Asia Heart Center, Canossa Hospital, 1 Old Peak Road, Hong
Kong
† The first two authors contributed equally to the
study.
*Corresponding author: Weijian Huang, MD; Department of
Cardiology, The First Affiliated Hospital of Wenzhou Medical University;
the Key Lab of Cardiovascular Disease of Wenzhou, Nanbaixiang, Wenzhou
325000, P.R. China. E-mail:weijianhuang69@126.com;
Funding: This work was supported by Key Research and
Development Program of Zhejiang (2019C03012), Major
Project
of the Science and Technology of Wenzhou (ZS2017010) and Project of the
Science and Technology of Wenzhou (Y20180647)
Disclosures: None
Abstract
Introduction: Transesophageal echocardiography (TEE) fails to
display optimal views to guide left atrial appendage closure (LAAC)
procedure in some patients due to atrio-esophageal anatomical
limitation. We aimed to investigate if intracardiac echocardiography
(ICE) conducted from left atrium (LA) achieves comparable multi-planar
views and clinical outcomes as TEE during LAAC.
Methods and Results: This study prospectively enrolled 102
consecutive patients with non-valvular atrial fibrillation receiving
LAmbre implants under local anesthesia at the First Affiliated Hospital
of Wenzhou Medical University from August 2018 to July 2019. The
procedures were guided by either ICE (n=40), TEE (n=50) or combined
ICE-TEE (n=12). A novel multi-angled “FLAVOR” approach was used in ICE
group for assessment. ICE allowed visualization of implanted device in
all patients at all proposed angles with long-axis views, while TEE
failed to do so in at least one of the angles in 36% of cases. In the
combined ICE-TEE cohort, TEE failed peri-device leak assessment in 2
patients. Rates of procedural success, recapture, resizing and
complications were similar between ICE and TEE groups. Fluoroscopy time,
radiation dose and volume of contrast use in ICE group were
significantly lower than the TEE cohort. At 45-day TEE follow-up, rate
and degree of peri-device leaks were similar between the ICE and TEE
groups.
Conclusions: A systematic approach using ICE to guide LAmbre
LAA occlusion was safe and feasible. This method was more reliable in
comprehensive, multi-angled imaging assessment, and achieving shorter
fluoroscopy time, lower radiation dose and less contrast use than TEE.
Keywords: intracardiac echocardiography; left atrial appendage
closure; transesophageal echocardiography;
atrial fibrillation