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 *
  1. Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou 325000, P.R. China.
  2. the Key Lab of Cardiovascular Disease of Wenzhou, Nanbaixiang, Wenzhou 325000, P.R. China.
  3. Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou 325000, P.R. China.
  4. 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