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Left Atrial Appendage Closure Under Intracardiac Echocardiographic Guidance: Feasibility and Comparison With Transesophageal Echocardiography

View Article: PubMed Central - PubMed

ABSTRACT

Background: Transcatheter left atrial appendage closure is an alternative therapy for stroke prevention in atrial fibrillation patients. These procedures are currently guided with transesophageal echocardiography and fluoroscopy in most centers. As intracardiac echocardiography (ICE) is commonly used in other catheter‐based procedures, we sought to determine the safety and effectiveness of intracardiac echocardiography–guided left atrial appendage closure with the Watchman device.

Methods and results: A total of 27 patients (11 males, 77.0±8.5 years) with atrial fibrillation receiving Watchman left atrial appendage closure under intracardiac echocardiography guidance at a single center were investigated. All patients were implanted successfully. There were no major procedural complications. The overall procedure‐related complication rate was 14.8%, mainly due to access site hematoma. Transesophageal echocardiography demonstrated successful closure of the left atrial appendage in all patients at 45 days after device implant.

Conclusions: Transcatheter left atrial appendage closure with intracardiac echocardiography guidance is safe and feasible.

No MeSH data available.


Related in: MedlinePlus

This figure demonstrates the ICE view of the left atrium (LA) and left atrial appendage (LAA) as seen from the right atrium. The long axis of the LAA, the left circumflex artery (black arrow), the mitral valve (MV), and the Watchman device (white arrow) are shown. ICE indicates intracardiac echocardiography; LV indicates left ventricle.
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jah31746-fig-0001: This figure demonstrates the ICE view of the left atrium (LA) and left atrial appendage (LAA) as seen from the right atrium. The long axis of the LAA, the left circumflex artery (black arrow), the mitral valve (MV), and the Watchman device (white arrow) are shown. ICE indicates intracardiac echocardiography; LV indicates left ventricle.

Mentions: A TEE was performed 1 to 7 days before the procedure to rule out the presence of intracardiac thrombus and to assess the dimensions and the morphology of the LAA. The LAA closure procedure was performed under ICE guidance in a catheterization laboratory with diagnostic imaging equipment. After cannulation of the femoral veins bilaterally, a standard transseptal access system and a 0.035‐inch guidewire with exchange length/extra support (eg, Amplatz Super stiff 260 cm) was introduced via the right femoral vein. An AcuNav ICE catheter was inserted via the left femoral vein and positioned in the right atrium. Location of the transseptal puncture was selected and confirmed by ICE. After transseptal puncture, a guidewire was advanced into the left upper pulmonary vein and the transseptal access system was removed. A single curved access sheath over 5‐Fr pigtail catheter was advanced into the left atrium, and selective LAA angiography was performed with the pigtail catheter (Figure). Prior to device delivery, the pigtail catheter was advanced into the distal portion of the LAA. Subsequently the access sheath was advanced to the distal aspect of the LAA. The marker bands (21, 27, and 33 mm) on the Watchman access sheath served as a guide for appropriate device selection and positioning. After removal of the pigtail catheter, an appropriately sized device based on ICE, LAA angiography, previous TEE measurements, and operator experience was slowly advanced in the access sheath. The device was deployed and/or repositioned until an optimal position was achieved with retraction of the access sheath. After confirming the absence of substantial residual leak by angiography and ICE, attachment of the device was checked with final tug test (a mechanical pulling test). The device was released after final confirmation by both ICE and angiography. Patients were hospitalized overnight and discharged the next day after exclusion of pericardial effusion by transthoracic echocardiography. At 45 days after implantation, a TEE was performed to assess for closure of the LAA as well as the absence of thrombus on the face of the device.


Left Atrial Appendage Closure Under Intracardiac Echocardiographic Guidance: Feasibility and Comparison With Transesophageal Echocardiography
This figure demonstrates the ICE view of the left atrium (LA) and left atrial appendage (LAA) as seen from the right atrium. The long axis of the LAA, the left circumflex artery (black arrow), the mitral valve (MV), and the Watchman device (white arrow) are shown. ICE indicates intracardiac echocardiography; LV indicates left ventricle.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121476&req=5

jah31746-fig-0001: This figure demonstrates the ICE view of the left atrium (LA) and left atrial appendage (LAA) as seen from the right atrium. The long axis of the LAA, the left circumflex artery (black arrow), the mitral valve (MV), and the Watchman device (white arrow) are shown. ICE indicates intracardiac echocardiography; LV indicates left ventricle.
Mentions: A TEE was performed 1 to 7 days before the procedure to rule out the presence of intracardiac thrombus and to assess the dimensions and the morphology of the LAA. The LAA closure procedure was performed under ICE guidance in a catheterization laboratory with diagnostic imaging equipment. After cannulation of the femoral veins bilaterally, a standard transseptal access system and a 0.035‐inch guidewire with exchange length/extra support (eg, Amplatz Super stiff 260 cm) was introduced via the right femoral vein. An AcuNav ICE catheter was inserted via the left femoral vein and positioned in the right atrium. Location of the transseptal puncture was selected and confirmed by ICE. After transseptal puncture, a guidewire was advanced into the left upper pulmonary vein and the transseptal access system was removed. A single curved access sheath over 5‐Fr pigtail catheter was advanced into the left atrium, and selective LAA angiography was performed with the pigtail catheter (Figure). Prior to device delivery, the pigtail catheter was advanced into the distal portion of the LAA. Subsequently the access sheath was advanced to the distal aspect of the LAA. The marker bands (21, 27, and 33 mm) on the Watchman access sheath served as a guide for appropriate device selection and positioning. After removal of the pigtail catheter, an appropriately sized device based on ICE, LAA angiography, previous TEE measurements, and operator experience was slowly advanced in the access sheath. The device was deployed and/or repositioned until an optimal position was achieved with retraction of the access sheath. After confirming the absence of substantial residual leak by angiography and ICE, attachment of the device was checked with final tug test (a mechanical pulling test). The device was released after final confirmation by both ICE and angiography. Patients were hospitalized overnight and discharged the next day after exclusion of pericardial effusion by transthoracic echocardiography. At 45 days after implantation, a TEE was performed to assess for closure of the LAA as well as the absence of thrombus on the face of the device.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Transcatheter left atrial appendage closure is an alternative therapy for stroke prevention in atrial fibrillation patients. These procedures are currently guided with transesophageal echocardiography and fluoroscopy in most centers. As intracardiac echocardiography (ICE) is commonly used in other catheter‐based procedures, we sought to determine the safety and effectiveness of intracardiac echocardiography–guided left atrial appendage closure with the Watchman device.

Methods and results: A total of 27 patients (11 males, 77.0±8.5 years) with atrial fibrillation receiving Watchman left atrial appendage closure under intracardiac echocardiography guidance at a single center were investigated. All patients were implanted successfully. There were no major procedural complications. The overall procedure‐related complication rate was 14.8%, mainly due to access site hematoma. Transesophageal echocardiography demonstrated successful closure of the left atrial appendage in all patients at 45 days after device implant.

Conclusions: Transcatheter left atrial appendage closure with intracardiac echocardiography guidance is safe and feasible.

No MeSH data available.


Related in: MedlinePlus