Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Clinical Electrophysiology, 9(12), 2587–2599. https://doi.org/10.1016/j.jacep.2023.08.004 Dr. Enrico G. Ferro et al.
Points
- In a large-scale comparison, intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) were utilized in left atrial appendage occlusion (LAAO) procedures, with ICE being less frequently used (5.7% of cases).
- Patients undergoing ICE-guided procedures had similar baseline characteristics and procedural times compared to those undergoing TEE-guided procedures but were less likely to receive general anesthesia.
- Both ICE and TEE achieved high rates of successful device implantation and complete seal at 45 days, with most adverse event rates showing no significant differences between the two groups.
- However, ICE was associated with significantly higher rates of pericardial effusion requiring intervention at 45 days, even after adjustment, highlighting a potential concern with this imaging modality.
- The study emphasized the potential impact of operator experience, as the rate of pericardial effusion requiring intervention decreased as operators performed more ICE-guided procedures. This suggests the importance of proficiency in utilizing ICE for LAAO procedures.
Summary
The study aimed to compare outcomes following intracardiac echocardiography (ICE), and transesophageal echocardiography (TEE) guided Watchman FLX implantation in the SURPASS (SURveillance Post Approval AnalySiS Plan) nationwide left atrial appendage occlusion (LAAO) registry. Between August 2020 and September 2021, LAAO was attempted in 39,759 patients at 698 sites, with 2,272 cases (5.7%) utilizing ICE and 31,835 (80.0%) utilizing TEE. The baseline characteristics and mean procedural times were similar between ICE and TEE patients, although ICE patients were less likely to receive general anesthesia (54% vs 98%, P < 0.01). Successful device implantation and complete seal rates at 45 days were comparable between the two groups, with most adverse event rates showing no significant differences. However, unadjusted and adjusted analyses revealed that ICE was associated with significantly higher rates of pericardial effusion requiring intervention at 45 days.
The findings from the largest comparison indicated that ICE use was infrequent, and both ICE and TEE achieved high rates of complete LAAO. However, ICE was linked to notably higher rates of pericardial effusion requiring intervention. Notably, the study highlighted that the rate of pericardial effusion requiring intervention decreased as operators performed more ICE-guided procedures, emphasizing the potential impact of operator experience on outcomes.
In conclusion, the study’s results provide valuable insights into the comparative outcomes of ICE- and TEE-guided Watchman FLX implantation in the context of LAAO, shedding light on the potential benefits and considerations associated with each imaging modality.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S2405500X23006175
References Ferro, E. G., Alkhouli, M., Nair, D. G., Kapadia, S. R., Hsu, J. C., Gibson, D. N., Freeman, J. V., Price, M. J., Roy, K., Allocco, D. J., Yeh, R. W., & Piccini, J. P. (2023). Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S. JACC: Clinical Electrophysiology, 9(12), 2587–2599. https://doi.org/10.1016/j.jacep.2023.08.004
