LAAO under miniaturized TEE probes safe and feasible with low rate of periprocedural complications

Among 546 patients treated across five European centres experienced in LAAO, the researchers reported high rates of technical and procedural success (98% and 97%, respectively), and only 2.9% of the patients experienced major periprocedural complications. Only four patients (0.7%) were required to be converted from conscious sedation to general anaesthesia owing to poor image quality. The findings were published online in the journal JACC: Cardiovascular Interventions.

Left atrial appendage occlusion has emerged as an alternative method for stroke prevention in atrial fibrillation patients who are not good candidates for chronic oral anticoagulation for whatever reason. This procedure will be used increasingly in the future, and there is a need to simplify the procedure to improve workflow and increase efficiency.

LAAO procedures are widely guided by standard TEE probes, requiring general anaesthesia in most patients. Miniaturized TEE probes use allows for LAAO guidance under local anaesthesia and offers an attractive imaging alternative to standard TEE probes.

Adel Aminian, Centre Hospitalier Universitaire de Charleroi, Belgium, and colleagues aimed to assess the efficacy and safety of miniaturized TEE probes for procedural guidance of LAAO.

For this purpose, the researchers performed a multicenter retrospective observational study of LAAO procedures performed under miniaturized TEE guidance and conscious sedation. The primary efficacy endpoint was determined as technical success. The secondary efficacy endpoint was determined as procedural success (technical success without major periprocedural complications). A composite of major periprocedural complications was determined as the safety outcome.

The study revealed the following findings:

• A total of 546 consecutive LAAO procedures were performed in 5 European centres.
• Technical success was achieved in 98.0% of patients. Sixteen major periprocedural complications occurred in 2.9% of patients, yielding a procedural success rate of 97.0%.
• Conversion to general anaesthesia was required in 4 patients. Short-term imaging follow-up was available in 422 patients with an incidence of major (>5 mm) TEE-detected residual leaks of 0.7%, complete LAA occlusion of 82.2% on cardiac computed tomography, and device-related thrombus of 5%.
• As compared with procedural 2-dimensional imaging for device sizing, preprocedural assessment by 3-dimensional imaging resulted in improved technical success (100% versus 95.0%).

"Miniaturized TEE probes designed for pediatric use appear to be a viable option for guiding LAAO in atrial fibrillation patients, allowing for the use of conscious sedation and streamlining of procedures," the researchers concluded.

Reference:

Aminian A, Leduc N, Freixa X, Swaans MJ, Ben Yedder M, Maarse M, Sanchis L, Cepas-Guillen P, Cruz-González I, Blanco-Fernandez F, Eschalier R, Boersma LVA. Left Atrial Appendage Occlusion Under Miniaturized Transesophageal Echocardiographic Guidance and Conscious Sedation: Multicenter European Experience. JACC Cardiovasc Interv. 2023 Aug 14;16(15):1889-1898. doi: 10.1016/j.jcin.2023.06.007. PMID: 37587597.