Intracardiac Versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion: The LAAO Italian Multicenter Registry

Sergio Berti, Luigi Emilio Pastormerlo, Gennaro Santoro, Elvis Brscic, Matteo Montorfano, Luigi Vignali, Paolo Danna, Claudio Tondo, Marco Rezzaghi, Gianpiero D'Amico, Amerigo Stabile, Salvatore Saccà, Giuseppe Patti, Antonio Rapacciuolo, Arnaldo Poli, Paolo Golino, Paolo Magnavacchi, Francesco Meucci, Bruno Pezzulich, Miroslava StolcovaGiuseppe Tarantini

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1086-1092
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume11
Issue number11
DOIs
Publication statusPublished - Jun 11 2018

Keywords

  • echocardiography
  • intracardiac
  • left atrial appendage occlusion
  • transesophageal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Berti, S., Pastormerlo, L. E., Santoro, G., Brscic, E., Montorfano, M., Vignali, L., Danna, P., Tondo, C., Rezzaghi, M., D'Amico, G., Stabile, A., Saccà, S., Patti, G., Rapacciuolo, A., Poli, A., Golino, P., Magnavacchi, P., Meucci, F., Pezzulich, B., ... Tarantini, G. (2018). Intracardiac Versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion: The LAAO Italian Multicenter Registry. JACC: Cardiovascular Interventions, 11(11), 1086-1092. https://doi.org/10.1016/j.jcin.2018.05.008