Policy, Payment & Practice -> Clinical Quality Measures and Outcomes D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-075 - Guidance Of Percutaneous Left Atrial Appendage Closure By Simultaneous Intracardiac And Transesophageal Echocardiography (ID 451)


Background: Outcomes of left atrial appendage occlusion (LAAO) device placement guided by contrast injection with intracardiac echo (ICE) or transesophageal echo (TEE) are similar. Whether the adequacy of LAAO guided by ICE would be improved by simultaneous assessment with TEE has not been examined.
Objective: To prospectively assess the outcome of WATCHMAN device placement guided by ICE and contrast injection using simultaneous TEE in a cohort of atrial fibrillation patients at The Ohio State University Wexner Medical Center.
Methods: Both TEE and ICE were successfully utilized simultaneously during LAAO in 20 patients (11 men, mean age 71, range 58-82 yrs.). ICE was used solely for procedural guidance and the operator was blinded to the findings of the TEE until adequate placement was verified by ICE and contrast injection. Prior to releasing the LAAO device, release criteria as assessed by ICE versus TEE were compared. Device redeployment was directed by TEE images, even when different from ICE.
Results: Pre-LAAO placement assessment of LAA dimensions by ICE (width 1.89 ±0.30 cm) was significantly smaller than TEE (width 2.02 ± 0.37 cm) (p = 0.02). Thus, in 2/6 (33%) patients who required repositioning, TEE imaging lead to redeployment despite ICE/contrast confirmation of adequate closure. In two cases, both imaging modalities identified an inadequate closure that the other modality did not identify. With simultaneous use of both imaging modalities and contrast injection, no patient had a significant peri-device leak at the end of the procedure or at 45 day follow up, and all systemic anticoagulants were discontinued.
Conclusion: ICE underestimated device sizing compared to TEE and assessment of LAAO placement guided by ICE/contrast with simultaneous TEE lead to frequent redeployment. Procedure quality may be enhanced by simultaneous TEE/ICE guidance as the follow-up rate of significant peri-device leak (> 5 mm) was 0% with this approach.