[Left atrial appendage closure guided with intracardiac echocardiographic probe via transesophageal route].

G Ital Cardiol (Rome)

Divisione di Cardiologia, Presidio Ospedaliero Umberto I, ASP 8 di Siracusa, Siracusa.

Published: November 2024

AI Article Synopsis

  • * Left atrial appendage closure (LAAC) is a viable option for these patients, and transesophageal echocardiography (TEE) is the traditional imaging method to assist in this procedure, although it typically requires general anesthesia, which poses additional risks for older adults.
  • * Intracardiac echocardiography (ICE) offers a "minimalist approach" that avoids anesthesia but has issues with image quality; recently, using ICE in conjunction with TEE (ICE-TEE) has

Article Abstract

Atrial fibrillation is the most common cardiac arrhythmia in adults and increases the risk of stroke 5-fold. In patients with non-valvular atrial fibrillation, left atrial appendage is the most common site for cardiac thrombus. For this reason, left atrial appendage closure (LAAC) represents an effective alternative to oral anticoagulants in patients who have relative or absolute contraindications to oral anticoagulation. Transesophageal echocardiography (TEE) is considered the gold standard imaging modality to guide LAAC. However, general anesthesia and tracheal intubation are often required with the TEE approach, increasing risks in elderly patients. There is an unmet need to overcome these limitations identifying an ideal "minimalist approach" to guide LAAC. Intracardiac echocardiography (ICE) represents a minimalist approach but it suffers from the lack of standardization and it may result in an suboptimal image quality compared with TEE. Another innovative approach is represented by the use of ICE via the transesophageal route (ICE-TEE), which has been already validated to identify the presence of left atrial appendage thrombi and to perform other procedures. In this paper, we suggest that ICE-TEE could be a good alternative imaging technique to guide the LAAC procedure without general anesthesia. A trial is ongoing to demonstrate its safety and effectiveness as ultrasound modality to guide LAAC.

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Source
http://dx.doi.org/10.1714/4371.43685DOI Listing

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