Intracardiac Echo useful alternative to TEE for elderly patients undergoing left atrial appendage closure

For putting Watchman FLX implants commonly transesophageal echocardiography is used for imaging. This procedure requires general anaesthesia and tracheal intubation. The setup is demanding with complications of general anaesthesia. Patients undergoing LAAC are elderly and cannot tolerate general anaesthesia so well. Therefore Intracardiac echocardiography (ICE) is a useful alternative to TEE with numerous advantages over TEE.

Demonstrating further, researchers investigated the efficacy and safety of ICE-guided LAAC with the Watchman FLX device.

The study summary includes the following:

• The ICE LAA (I Can See Left Atrial Appendage) study was a prospective, multicenter study.
• Patients with atrial fibrillation with CHA2DS2-VASc scores ≥2 and clinical indications for LAAC were eligible.
• Preplanning before LAAC was mandatory (within seven days).
• Intraprocedural ICE was carried out from the left atrium.
• The rate of significant peri-device leaks (>5 mm) at 45-day TEE was the primary outcome measured in the study.
• One hundred patients enrolled had a mean age of 76 years, with a mean CHA2DS2-VASc score and HAS-BLED score of 4.0 ± 1.5 and 2.5 ± 0.9, respectively.
• Significant peridevice leak (>5 mm) was 0%.
• Those evaluated by TEE at 45 days had effective left atrial appendage closure.
• All patients received Watchman FLX devices, and technical success was 100%.
• The number of devices per case was 1.0 ± 0.1.

To conclude, ICE successfully guided the assessment of device release criteria, including device compression of 19.2% ± 7.1% and recommended range: of 10%-30%.

No subject required conversion to TEE.

Procedural complications were four access-site bleeds. There was no complications at 45 day follow up period like stroke, embolization, transient ischemic attack,  pericardial effusion, device embolization and thrombus.

ICE successfully guide LAAC with the Watchman FLX,

Further reading:

Nielsen-Kudsk J, Berti S, Caprioglio F, et al. Intracardiac Echocardiography to Guide Watchman FLX Implantation. J Am Coll Cardiol Intv. null2023, 0 (0) .https://doi.org/10.1016/j.jcin.2022.10.024