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

The elevated radiation exposure and potential impact on Conflict of interest
kidney function must be considered and discussed with
the patients. The authors declare they have no competing interests.
The technical aspects of 3D ICE can be mastered Author contributions
through structured learning. Due to its distinctive Conceptualization: Ashok Chaudhary
characteristics compared with other echocardiographic Writing – original draft: All authors
techniques, specialized education is necessary for Writing – review & editing: All authors
training in ICE catheter manipulation, image acquisition,
and interpretation. Key elements of training include Ethics and consent to participate
understanding ultrasound physics, individualized
instruction for structural heart interventions, and hands-on Not applicable.
practice using advanced equipment in a controlled animal Consent for publication
model. Operators should gain procedural experience under
20
expert supervision at high-volume centers and be equipped Not applicable.
to diagnose and manage complications. The absence of
20
precise data regarding the number of procedures required Availability of data
for ICE competency presents a challenge, especially with Not applicable.
continuous development of imaging technology. To ensure
proficiency and minimize complications, a consensus on References
the minimum number of ICE-guided procedures feasible 1. Zhang L, Xie Y, Ren Z, Xie M. Transesophageal
at low-volume sites must be reached. The 2019 guidelines echocardiography related complications. Front Cardiovasc
from the American College of Cardiology, American Heart Med. 2024;11:1410594.
Association, and American Society of Echocardiography doi: 10.3389/fcvm.2024.1410594
recommend a minimum of 10 cases to achieve level III
structural heart echocardiography competency. New 2. Patel KM, Desai RG, Trivedi K, Neuburger PJ, Krishnan S,
20
users may wish to perform their initial cases of 3D ICE with Potestio CP. Complications of transesophageal
echocardiography: A review of injuries, risk factors,
TEE as a backup imaging technique. This will help enhance and management. J Cardiothorac Vasc Anesth. 2022;
operator experience and the confidence of the cardiac team 36(8):3292-3302.
in this technology. Eventually, 3D ICE may become the
preferred imaging modality for all users and will become doi: 10.1053/j.jvca.2022.02.015
key to a minimalist approach to LAAO interventions. 3. Diaz JC, Duque M, Marin J, et al. Intracardiac
echocardiography-guided left atrial appendage occlusion.
4. Conclusion Arrhythm Electrophysiol Rev. 2024;13:e03.
TEE has been the primary method for guiding LAAO doi: 10.15420/aer.2023.29
procedures and is the most widely used imaging modality. 4. Ramesh T, Budhiraja M, Mehta V, Rajsheker S, Arif I,
However, it has significant disadvantages, such as the Sukhija R. Tct-698 intracardiac echocardiography versus
need for sedation or general anesthesia for esophageal transesophageal echocardiography for procedural guidance
intubation, an elevated risk of esophageal injury, and in patients undergoing left atrial appendage occlusion:
reliance on a specialized echocardiography operator. A A single-center retrospective review. J Am Coll Cardiol.
1,21
single-center observational study demonstrated that using 2023;82(17):B280-B281.
a minimalist approach with 3D ICE guidance for LAAO doi: 10.1016/j.jacc.2023.09.709
procedures under moderate sedation was both feasible and 5. Reddy VY, Doshi SK, Kar S, et al. 5-year outcomes
comparable to TEE in all patients. Utilizing 3D ICE can after left atrial appendage closure. J Am Coll Cardiol.
enhance the safety and efficacy of procedures, reduce costs, 2017;70(24):2964-2975.
and increase patient satisfaction. 3,22
doi: 10.1016/j.jacc.2017.10.021
Acknowledgments 6. Jhand A, Goldsweig AM. The emerging role of intracardiac
None. echocardiography (ICE) in left atrial appendage closure
(LAAC). Curr Cardiol Rep. 2023;25(10):1223-1232.
Funding doi: 10.1007/s11886-023-01940-4
None. 7. Nielsen-Kudsk J, Berti S, Caprioglio F, et al. Intracardiac

Volume 2 Issue 4 (2024) 9 doi: 10.36922/bh.4018