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