Sergio Berti1, Luigi Emilio Pastormerlo2, Gennaro Santoro3, Elvis Brscic4, Matteo Montorfano5, Luigi Vignali6, Paolo Danna7, Claudio Tondo8, Marco Rezzaghi2, Gianpiero D'Amico9, Amerigo Stabile10, Salvatore Saccà11, Giuseppe Patti12, Antonio Rapacciuolo13, Arnaldo Poli14, Paolo Golino15, Paolo Magnavacchi16, Francesco Meucci3, Bruno Pezzulich4, Miroslava Stolcova2, Giuseppe Tarantini9. 1. UOC Cardiologia Diagnostica ed Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy. Electronic address: berti@ftgm.it. 2. UOC Cardiologia Diagnostica ed Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy. 3. UO Cardiologia Generale, Azienda Ospedaliero-Universitaria di Careggi, Firenze, Italy. 4. UO Cardiologia, Maria Pia Hospital, Turin, Italy. 5. UO Cardiologia Interventistica ed Emodinamica, Ospedale San Raffaele, Milan, Italy. 6. UO Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. 7. UO Cardiologia, Ospedale Luigi Sacco, Milan, Italy. 8. Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Università di Milan, Milan, Italy. 9. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 10. UO Cardiologia, Maria Eleonora Hospital, Palermo, Italy. 11. UOC Cardiologia, ULSS13 Mirano, Mirano, Italy. 12. UOS di Servizi Cardiologici, Campus Bio-medico, Rome, Italy. 13. Department of advanced biomedical sciences, Federico II University, Naples, Italy. 14. USD Cardiologia Interventistica-ASST Ovest Milanese-Ospedale Legnano-Magenta, Legnano, Italy. 15. UOC Cardiologia Clinica, Azienda Ospedaliera "Sant'Anna e San Sebastiano" di Caserta, Caserta, Italy. 16. UO Cardiologia, Policlinico di Modena-Ospedale di Baggiovara, Modena, Italy.
Abstract
OBJECTIVES: This study sought to evaluate the feasibility, safety, and efficacy of intracardiac echocardiography (ICE)-guided versus transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) by the use of Amplatzer Cardiac Plug or Amulet devices included in a large Italian registry. BACKGROUND: TEE is widely used for LAAO procedure guidance. ICE may be a potential alternative imaging modality in LAAO. METHODS: Data from 604 LAAO procedures performed in 16 Italian centers were reviewed. ICE-guided LAAO was performed in 187 patients, whereas TEE was used in 417 patients. Procedural success was defined as LAAO without occurrence of pericardial tamponade, stroke, systemic embolism with end organ damage, major bleeding, and device embolization. Stroke, transient ischemic attack, major bleeding, overall and cardiovascular death were analyzed. RESULTS: CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65 to 74 years, sex category) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol) scores were similar between the ICE and TEE groups. TEE implied lower procedural (delta 12 min) and fluoroscopy time (delta 5 min) when compared with ICE. Procedural success was similarly high (≥94%) between the TEE and ICE groups with a complication rate of 6.5% for TEE versus 4.2% for ICE (odds ratio: 1.468; 95% confidence interval: 0.681 to 3.166; p = 0.327). At median follow-up of 451 days (interquartile range: 162 to 899 days), the rate of cerebral ischemic events was similar between TEE-guided and ICE-guided procedures. CONCLUSIONS: ICE-guided LAAO by means of Amplatzer devices may represent a second alternative imaging modality after an appropriate learning curve and bearing in mind that pre-procedural computed tomography imaging is mandatory. When comparing ICE with TEE, TEE remains the gold standard.
OBJECTIVES: This study sought to evaluate the feasibility, safety, and efficacy of intracardiac echocardiography (ICE)-guided versus transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) by the use of Amplatzer Cardiac Plug or Amulet devices included in a large Italian registry. BACKGROUND: TEE is widely used for LAAO procedure guidance. ICE may be a potential alternative imaging modality in LAAO. METHODS: Data from 604 LAAO procedures performed in 16 Italian centers were reviewed. ICE-guided LAAO was performed in 187 patients, whereas TEE was used in 417 patients. Procedural success was defined as LAAO without occurrence of pericardial tamponade, stroke, systemic embolism with end organ damage, major bleeding, and device embolization. Stroke, transient ischemic attack, major bleeding, overall and cardiovascular death were analyzed. RESULTS: CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65 to 74 years, sex category) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol) scores were similar between the ICE and TEE groups. TEE implied lower procedural (delta 12 min) and fluoroscopy time (delta 5 min) when compared with ICE. Procedural success was similarly high (≥94%) between the TEE and ICE groups with a complication rate of 6.5% for TEE versus 4.2% for ICE (odds ratio: 1.468; 95% confidence interval: 0.681 to 3.166; p = 0.327). At median follow-up of 451 days (interquartile range: 162 to 899 days), the rate of cerebral ischemic events was similar between TEE-guided and ICE-guided procedures. CONCLUSIONS: ICE-guided LAAO by means of Amplatzer devices may represent a second alternative imaging modality after an appropriate learning curve and bearing in mind that pre-procedural computed tomography imaging is mandatory. When comparing ICE with TEE, TEE remains the gold standard.
Authors: Fareed Moses S Collado; Claudia M Lama von Buchwald; Christina K Anderson; Nidhi Madan; Hussam S Suradi; Henry D Huang; Hani Jneid; Clifford J Kavinsky Journal: J Am Heart Assoc Date: 2021-10-20 Impact factor: 5.501