Page 27 - BH-2-4

Brain & Heart Step by step 3D ICE guided LAA occlusion

A B

Figure 7. Nuvision 4D ICE was employed for Amulet LAAO. (A) Gentle tug test of the Amulet disc to assess its stability. (B) 3D MPR views to check for
position, compression, and leak.
Abbreviations: ICE: Intracardiac echocardiography, LAAO: Left atrial appendage occlusion.

Table 3. Procedural duration Table 4. Procedural outcome

Duration (min) TEE and ICE ICE Procedural outcomes TEE and ICE ICE
(n=7) (n=13) (n=7) (%) (n=13) (%)
Patient in room to patient out 144 125 Technical success 100 100
Skin to skin 102 89 Periprocedural complications 0 0
ICE in to ICE out 65 63 Procedures with device resizing 0 0
TEE in to TEE out 82 N/A Average number of devices used 1 1
ICE insertion to septal crossing 20 16 General anesthesia 100 15
Septal crossing to device deployment 34 30 Moderate sedation 0 70
Fluoroscopy duration 28.4 24.9 Monitored anesthetic care w/o intubation 0 15
Abbreviations: TEE, transesophageal echocardiography; Average length of stay 1 (days) 0.5 (days)
ICE: Intracardiac echocardiography. Follow-up (6 weeks)
Peri-device leak 0 0
In Group 1, all patients received general anesthesia with
mechanical ventilation. In Group 2, 70% of the patients Device-related thrombus 0 0
received moderate sedation, 15% received monitored MACCE events 0 0
anesthetic care without intubation, and 15% received Abbreviations: TEE: Transesophageal echocardiography;
general anesthesia and mechanical ventilation based on ICE: Intracardiac echocardiography.
patient preference/body habitus. Following the procedure,
all patients received dual antiplatelet therapy for 3 months, ventilation and TEE for LAAO. ICE guidance, primarily
and they were subsequently prescribed low-dose aspirin 2D and occasionally 3D is employed in a limited number
11,17
alone. In Group 1, the average post-procedural length of cases. This single-center observational study
demonstrated that the minimalist approach of 3D ICE
of stay (excluding LOS due to other medical issues) was guidance for LAAO procedure with moderate sedation
1.0 day, whereas that in Group 2 was 0.5 day. In either and same-day discharge was both feasible and comparable
group, no PDL or device-related thrombus was detected to TEE in all patients. However, our sample size was
at the 6-week follow-up. Both groups experienced no insufficient to derive any definitive conclusions. A more
major adverse cardiac or cerebrovascular events after the extensive study with longer longitudinal follow-up is
procedure. In addition, there were no local or systemic warranted to verify these findings. High success rates
bleeding complications (Table 4). can be achieved using 3D ICE-guided LAAO with no
3. Discussion significant adverse events. 7,14,18 In addition, pre-procedural
cardiac CTA and routine use of predictive AI-based
The LAAO procedure is a feasible alternative to simulation tools such as FEops can aid in simplifying the
anticoagulant therapy for stroke prevention in patients with planning of the procedure. If feasible, patients may prefer
19
atrial fibrillation who cannot tolerate anticoagulation. 16,17 to undergo follow-up using CTA rather than TEE, which
Most centers employ general anesthesia with mechanical can prevent the need for additional invasive procedures.

Volume 2 Issue 4 (2024) 8 doi: 10.36922/bh.4018