Intracardiac Echocardiography-Guided Left Atrial Appendage Closure With a Novel Foam-Based Conformable Device

2021 ◽  
Author(s):  
Mohit K. Turagam ◽  
Petr Neuzil ◽  
Pavel Hala ◽  
Tomas Mraz ◽  
Srinivas R. Dukkipati ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Intracardiac Echocardiography ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure

scholarly journals 4D Volume Intracardiac Echocardiography for Intraprocedural Guidance of Transcatheter Left Atrial Appendage Closure

2019 ◽  
Vol 12 (4) ◽  
Author(s):  
Houman Khalili ◽  
Marquand Patton ◽  
Haider Al Taii ◽  
Priya Bansal ◽  
Matthew Brady ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Intracardiac Echocardiography ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure

scholarly journals Periprocedural Intracardiac Echocardiography for Left Atrial Appendage Closure

2014 ◽  
Vol 7 (9) ◽  
pp. 1036-1044 ◽  
Author(s):  
Sergio Berti ◽  
Umberto Paradossi ◽  
Francesco Meucci ◽  
Giuseppe Trianni ◽  
Apostolos Tzikas ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Intracardiac Echocardiography ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure

scholarly journals Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero-fluoroscopy atrial fibrillation ablation procedures

2021 ◽  
Author(s):  
yi he chen ◽  
Liangguo Wang ◽  
Xiaodong Zhou ◽  
ying fang ◽  
Lan Su ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Intracardiac Echocardiography ◽  
Atrial Appendage ◽  
Adverse Event Rate ◽  
Left Atrial Appendage Closure ◽  
Zero Fluoroscopy

Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) is sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. To evaluate the clinical outcomes and safety of ICE guided LAAC within a zero-fluoroscopy catheter ablation procedure. Methods and Results:From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC was achieved in all patients. Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 77.8% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA2DS2-VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to a single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.F Du ◽  
H.M Chu ◽  
C.J Shen ◽  
B He
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Pulmonary Veins ◽  
Intracardiac Echocardiography ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Landing Zone ◽  
Electroanatomic Mapping System ◽  
The Mean ◽  
Fluoroscopy Exposure

Abstract Background Percutaneous left atrial appendage closure (LAAC) is currently guided by fluoroscopy and transesophageal echocardiography (TEE). Objective We report an LAAC technique using intracardiac echocardiography (ICE) and electroanatomic mapping system (EAMS) under local anesthesia without fluoroscopy exposure. Methods Seven non-valvular atrial fibrillation (NVAF) patients with high risk of stroke and bleeding (male 5/7, aged 71.7±8.8 years, mean CHA2DS2-VASc score 5.1±2.1; mean HAS-BLED score 3.0±1.2) were enrolled. ICE probe was advanced into left atrium (LA) navigated by the EAMS. LAA sizing and LAmbreTM device implantation were guided by ICE following the orthogonal tri-axial algorithm (Axis-X: from left pulmonary veins [LPVs] to LAA; Axis-Y: from right PV ostium to LAA; Axis-Z: from lower LA to LAA). Results There were two cauliflower-like, two chicken-wing-like and three cactus-like LAAs. The mean diameters of ostia and landing zone were 21.4±3.9mm and 20.4±4.2mm, respectively. LAmbre devices with a mean umbrella diameter of 23.7±4.2mm and cover disc diameter of 29.4±3.6mm were successfully implanted and acute complete LAA sealing without peri-device leak (PDL) were achieved in all cases. The mean procedural duration was 73.0±21.4min. No fluoroscopy exposure nor contrast consumption were recorded. No procedure-related complications were documented. The PDL at 45-day follow-up was 1.7±0.8mm. No stroke or thromboembolic events were documented. Conclusions The fluoroscopic exposure could be minimized, even to zero, in the ICE-guided LAAC procedures feasibly and safely using LAmbre devices. The orthogonal tri-axial assessment is considered efficacious and safe for the procedures. Orthogonal tri-axial algorithm Funding Acknowledgement Type of funding source: None

Clinical benefits of the orthogonal tri-axial technique in the left atrial appendage closure procedures

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.F Du ◽  
H.M Chu ◽  
G.H Fu ◽  
B.H Wang
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Pulmonary Veins ◽  
Intracardiac Echocardiography ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Electroanatomic Mapping System ◽  
Device Implantation ◽  
Clinical Benefits ◽  
Thromboembolism Events

Abstract Background Intracardiac echocardiography (ICE) has been an alternative imaging guidance of transesophageal echocardiography (TEE) in the left atrial appendage closure (LAAC) procedures. However, its application experience is limited. Objective We aimed to analyze the clinical benefits of an orthogonal tri-axial (OTA) technique using ICE and electroanatomic mapping system (EAMS) in the LAAC procedures. Methods This retrospective study enrolled 52 atrial fibrillation (AF) patients with high risks of stroke and/or bleeding (CHA2DS2-VASc score 4.67±1.48; HAS-BLED score 2.87±0.94) who underwent the LAAC procedures following the OTA technique (ICE group). ICE probe was advanced into left atrium (LA) navigated by the EAMS. Evaluation of sizing and device implantation were performed from three orthogonal axes including axis-X: from left pulmonary veins (PVs) to LAA; axis-Y: from right PV ostium to LAA; axis-Z: from lower LA to LAA. Procedure-related parameters and clinical outcomes were compared to those from another 52 patients with comparable baseline characteristics who underwent LAAC following the TEE guidance (TEE group). All procedures were achieved under local anesthesia. Results The fluoroscopic exposure (99.5±113.6 vs 229.0±135.4mGy, P<0.001) and time (5.9±4.7 vs 8.1±3.9min, P=0.011) and contrast consumption (66.5±54.9 vs 124.1±69.6ml, P<0.001) in the ICE group were significantly lower than those in the TEE group, respectively, without increasing the procedural time (79.6±24.4 vs 82.3±39.5min, P=0.674). Similar proportions of Watchman (26 vs 32, P=0.236) and ACP (10 vs 13, P=0.478) devices were recorded between groups while more LAmbre devices were applied in the ICE group (16 vs 7, P=0.033). All procedures were accomplished successfully. The fluoroscopic exposure (22.9±32.7 vs 228.9±148.6mGy, P<0.001) and time (1.9±2.9 vs 9.9±5.0min, P<0.001), the contrast consumption (17.7±21.7 vs 124.6±62.8ml, P<0.001) and the procedural duration (74.6±19.7 vs 88.1±20.6min, P=0.107) were lower in the last 25% cases in the ICE group compared to the first 25% cases. Both acute and long-term (during the 45-day and 6-month follow-ups) peri-device leaks (PDLs) were similar between groups. No procedure-related complications or thromboembolism events were observed. Conclusions The advantage of the ICE- plus EAMS-guided LAAC in fluoroscopic exposure and contrast consumption minimizing could be expected following the OTA technique. Procedural efficiency improves after the learning curve. Funding Acknowledgement Type of funding source: None

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