Skip to main content
Erschienen in: The International Journal of Cardiovascular Imaging 10/2018

22.05.2018 | Original Paper

Feasibility of intracardiac echocardiography imaging from the left superior pulmonary vein for left atrial appendage occlusion

verfasst von: Do Young Kim, Seung Yong Shin, Jin-Seok Kim, Seong Hwan Kim, Young-Hoon Kim, Hong Euy Lim

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 10/2018

Einloggen, um Zugang zu erhalten

Abstract

Intracardiac echocardiography (ICE) is considered an alternative imaging modality for left atrium appendage occlusion (LAAO) to avoid general anesthesia. However, the quality of ICE images obtained from right atrium can be suboptimal compared with transesophageal echocardiography (TEE) imaging. Although placing an ICE probe into left atrium can improve imaging quality, there are limited data regarding procedure outcomes of ICE-guided LAAO versus TEE-guided LAAO. One hundred forty four patients who underwent LAAO with Amplatzer Cardiac Plug, Amulet, or Watchman device were enrolled from two referral institutes. TEE-guided LAAO was performed under general anesthesia or deep sedation (n = 103), and ICE-guided LAAO was conducted under local anesthesia (n = 41). An ICE probe was placed into left superior pulmonary vein (LSPV) via transseptal approach. The procedure success and complication rates of the ICE-guided LAAO were comparable with the TEE-guided LAAO (100 vs. 97.1%, p = 1.0; 2.4 vs. 6.8%, p = 0.734, respectively). The procedure time and total radiation dose were significantly lower in ICE-guided group compared with TEE-guided group (58.0 [55.0, 61.0] min vs. 80.0 [58.0, 95.0] min, p < 0.001; 456.0 [359.0, 604.0] mGy vs. 625.0 [439.0, 1502.5] mGy, p < 0.001, respectively). In multivariate analysis, younger age, the last time period of procedure, and local anesthesia were independent factors affecting shorter procedure time. ICE imaging from the LSPV provided optimal views for LAAO procedure with a significant reduction of total procedure time through performing under local anesthesia. This approach can be very useful for LAAO procedure especially in patients who are ineligible for general anesthesia.
Literatur
1.
Zurück zum Zitat Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP et al (2006) Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 114:119–125CrossRefPubMed Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP et al (2006) Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 114:119–125CrossRefPubMed
2.
Zurück zum Zitat Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRefPubMed Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRefPubMed
3.
Zurück zum Zitat Nieuwlaat R, Capucci A, Camm AJ, Olsson SB, Andresen D, Davies DW et al (2005) Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 26:2422–2434CrossRefPubMed Nieuwlaat R, Capucci A, Camm AJ, Olsson SB, Andresen D, Davies DW et al (2005) Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 26:2422–2434CrossRefPubMed
4.
Zurück zum Zitat Saw J, Lempereur M (2014) Percutaneous left atrial appendage closure: procedural techniques and outcomes. JACC Cardiovasc Interv 7:1205–1220CrossRefPubMed Saw J, Lempereur M (2014) Percutaneous left atrial appendage closure: procedural techniques and outcomes. JACC Cardiovasc Interv 7:1205–1220CrossRefPubMed
5.
Zurück zum Zitat Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S (2011) Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation 123:417–424CrossRefPubMed Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S (2011) Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation 123:417–424CrossRefPubMed
6.
Zurück zum Zitat Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK et al (2014) Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol 64:1–12CrossRefPubMed Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK et al (2014) Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol 64:1–12CrossRefPubMed
7.
Zurück zum Zitat Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M et al (2009) Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 374:534–542CrossRefPubMed Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M et al (2009) Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 374:534–542CrossRefPubMed
8.
10.
Zurück zum Zitat Berti S, Paradossi U, Meucci F, Trianni G, Tzikas A, Rezzaghi M et al (2014) Periprocedural intracardiac echocardiography for left atrial appendage closure: a dual-center experience. JACC Cardiovasc Interv 7:1036–1044CrossRefPubMed Berti S, Paradossi U, Meucci F, Trianni G, Tzikas A, Rezzaghi M et al (2014) Periprocedural intracardiac echocardiography for left atrial appendage closure: a dual-center experience. JACC Cardiovasc Interv 7:1036–1044CrossRefPubMed
11.
Zurück zum Zitat Frangieh AH, Alibegovic J, Templin C, Gaemperli O, Obeid S, Manka R et al (2017) Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman. Catheter Cardiovasc Interv 90:331–338CrossRefPubMed Frangieh AH, Alibegovic J, Templin C, Gaemperli O, Obeid S, Manka R et al (2017) Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman. Catheter Cardiovasc Interv 90:331–338CrossRefPubMed
13.
Zurück zum Zitat Saw J (2017) Intracardiac echocardiography for endovascular left atrial appendage closure: is it ready for primetime? JACC Cardiovasc Interv 10:2207–2210CrossRefPubMed Saw J (2017) Intracardiac echocardiography for endovascular left atrial appendage closure: is it ready for primetime? JACC Cardiovasc Interv 10:2207–2210CrossRefPubMed
15.
Zurück zum Zitat Berti S, Santoro G, Palmieri C, Meucci F (2013) Tools and techniques clinical: transcatheter closure of left atrial appendage using the Amplatzer Cardiac Plug. EuroIntervention 9:524–526CrossRefPubMed Berti S, Santoro G, Palmieri C, Meucci F (2013) Tools and techniques clinical: transcatheter closure of left atrial appendage using the Amplatzer Cardiac Plug. EuroIntervention 9:524–526CrossRefPubMed
16.
Zurück zum Zitat Hijazi ZM, Shivkumar K, Sahn DJ (2009) Intracardiac echocardiography during interventional and electrophysiological cardiac catheterization. Circulation 119:587–596CrossRefPubMedPubMedCentral Hijazi ZM, Shivkumar K, Sahn DJ (2009) Intracardiac echocardiography during interventional and electrophysiological cardiac catheterization. Circulation 119:587–596CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Anter E, Silverstein J, Tschabrunn CM, Shvilkin A, Haffajee CI, Zimetbaum PJ et al (2014) Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages. Heart Rhythm 11:1890–1897CrossRefPubMed Anter E, Silverstein J, Tschabrunn CM, Shvilkin A, Haffajee CI, Zimetbaum PJ et al (2014) Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages. Heart Rhythm 11:1890–1897CrossRefPubMed
18.
Zurück zum Zitat Aguirre D, Pincetti C, Perez L, Deck C, Alfaro M, Vergara MJ et al (2018) Single trans-septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure. Catheter Cardiovasc Interv 91:356–361CrossRefPubMed Aguirre D, Pincetti C, Perez L, Deck C, Alfaro M, Vergara MJ et al (2018) Single trans-septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure. Catheter Cardiovasc Interv 91:356–361CrossRefPubMed
19.
Zurück zum Zitat Shah KB, Kleinman BS, Rao TL, Jacobs HK, Mestan K, Schaafsma M (1990) Angina and other risk factors in patients with cardiac diseases undergoing noncardiac operations. Anesth Analg 70:240–247CrossRefPubMed Shah KB, Kleinman BS, Rao TL, Jacobs HK, Mestan K, Schaafsma M (1990) Angina and other risk factors in patients with cardiac diseases undergoing noncardiac operations. Anesth Analg 70:240–247CrossRefPubMed
20.
Zurück zum Zitat Aronow WS, Ahn C, Gutstein H (1996) Prevalence of atrial fibrillation and association of atrial fibrillation with prior and new thromboembolic stroke in older patients. J Am Geriatr Soc 44:521–523CrossRefPubMed Aronow WS, Ahn C, Gutstein H (1996) Prevalence of atrial fibrillation and association of atrial fibrillation with prior and new thromboembolic stroke in older patients. J Am Geriatr Soc 44:521–523CrossRefPubMed
21.
Zurück zum Zitat Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV et al (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375CrossRefPubMed Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV et al (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375CrossRefPubMed
22.
Zurück zum Zitat Korsholm K, Jensen JM, Nielsen-Kudsk JE (2017) Intracardiac echocardiography from the left atrium for procedural guidance of transcatheter left atrial appendage occlusion. JACC Cardiovasc Interv 10:2198–2206CrossRefPubMed Korsholm K, Jensen JM, Nielsen-Kudsk JE (2017) Intracardiac echocardiography from the left atrium for procedural guidance of transcatheter left atrial appendage occlusion. JACC Cardiovasc Interv 10:2198–2206CrossRefPubMed
23.
Zurück zum Zitat Bartel T, Müller S, Biviano A, Hahn RT (2014) Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn. Eur Heart J 35:69–76CrossRefPubMed Bartel T, Müller S, Biviano A, Hahn RT (2014) Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn. Eur Heart J 35:69–76CrossRefPubMed
24.
Zurück zum Zitat Alboliras ET, Hijazi ZM (2004) Comparison of costs of intracardiac echocardiography and transesophageal echocardiography in monitoring percutaneous device closure of atrial septal defect in children and adults. Am J Cardiol 94:690–692CrossRefPubMed Alboliras ET, Hijazi ZM (2004) Comparison of costs of intracardiac echocardiography and transesophageal echocardiography in monitoring percutaneous device closure of atrial septal defect in children and adults. Am J Cardiol 94:690–692CrossRefPubMed
Metadaten
Titel
Feasibility of intracardiac echocardiography imaging from the left superior pulmonary vein for left atrial appendage occlusion
verfasst von
Do Young Kim
Seung Yong Shin
Jin-Seok Kim
Seong Hwan Kim
Young-Hoon Kim
Hong Euy Lim
Publikationsdatum
22.05.2018
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 10/2018
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-018-1374-5

Weitere Artikel der Ausgabe 10/2018

The International Journal of Cardiovascular Imaging 10/2018 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.