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Left atrial appendage occlusion using intracardiac echocardiography

  • Apoor Patel
    Affiliations
    Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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  • Rajesh Venkataraman
    Affiliations
    Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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  • Paul Schurmann
    Affiliations
    Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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  • Amish Dave
    Affiliations
    Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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  • Miguel Valderrábano
    Correspondence
    Address reprint requests and correspondence: Dr Miguel Valderrábano, Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Suite 1901, Houston, TX 77030.
    Affiliations
    Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
    Search for articles by this author
Published:October 04, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.09.021
      Left atrial appendage (LAA) closure (LAAC) has emerged as an alternative prevention strategy for patients with nonvalvular atrial fibrillation and contraindications to long-term anticoagulation.
      • Reddy V.Y.
      • Doshi S.K.
      • Kar S.
      • et al.
      5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials.
      In randomized trials studying the Watchman device (Boston Scientific, St. Paul, MN), implantation was performed under transesophageal echocardiography (TEE) guidance.
      • Reddy V.Y.
      • Doshi S.K.
      • Kar S.
      • et al.
      5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials.
      The use of TEE often mandates the presence of general anesthesia and an additional cardiologist or anesthesiologist to perform TEE. This uses greater health care resources and adds additional complexity to the procedure. Alternatively, there is a growing interest in intracardiac echocardiography (ICE)–guided LAAC and we herein describe a systematic approach to obtain appropriate views of the LAA with ICE. While our experience is predominantly with the Watchman device, this approach is applicable to other LAAC devices as well.
      • Berti S.
      • Pastormerlo L.E.
      • Santoro G.
      • et al.
      Intracardiac versus transesophageal echocardiographic guidance for left atrial appendage occlusion: the LAAO Italian Multicenter Registry.

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      References

        • Reddy V.Y.
        • Doshi S.K.
        • Kar S.
        • et al.
        5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials.
        J Am Coll Cardiol. 2017; 70: 2964-2975
        • Berti S.
        • Pastormerlo L.E.
        • Santoro G.
        • et al.
        Intracardiac versus transesophageal echocardiographic guidance for left atrial appendage occlusion: the LAAO Italian Multicenter Registry.
        JACC Cardiovasc Interv. 2018; 11: 1086-1092
        • Hemam M.E.
        • Kuroki K.
        • Schurmann P.A.
        • et al.
        Left atrial appendage closure with the Watchman device using intracardiac vs transesophageal echocardiography: procedural and cost considerations.
        Heart Rhythm. 2019; 16: 334-342
        • Alkhouli M.
        • Chaker Z.
        • Alqahtani F.
        • Raslan S.
        • Raybuck B.
        Outcomes of routine intracardiac echocardiography to guide left atrial appendage occlusion.
        JACC Clin Electrophysiol. 2020; 6: 393-400
        • Frangieh A.H.
        • Alibegovic J.
        • Templin C.
        • et al.
        Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with Watchman.
        Catheter Cardiovasc Interv. 2017; 90: 331-338
        • Mosleh W.
        • Sheikh A.
        • Said Z.
        • et al.
        The use of cardiac-CT alone to exclude left atrial thrombus before atrial fibrillation ablation: efficiency, safety, and cost analysis.
        Pacing Clin Electrophysiol. 2018; 41: 727-733
        • Anter E.
        • Silverstein J.
        • Tschabrunn C.M.
        • et al.
        Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages.
        Heart Rhythm. 2014; 11: 1890-1897