Author + information
- Received January 16, 2018
- Revision received May 3, 2018
- Accepted May 3, 2018
- Published online June 4, 2018.
- Sergio Berti, MDa,∗ (, )
- Luigi Emilio Pastormerlo, MD, PhDa,
- Gennaro Santoro, MDb,
- Elvis Brscic, MDc,
- Matteo Montorfano, MDd,
- Luigi Vignali, MD, PhDe,
- Paolo Danna, MD, PhDf,
- Claudio Tondo, MD, PhDg,
- Marco Rezzaghi, MDa,
- Gianpiero D’Amico, MDh,
- Amerigo Stabile, MDi,
- Salvatore Saccà, MDj,
- Giuseppe Patti, MDk,
- Antonio Rapacciuolo, MD, PhDl,
- Arnaldo Poli, MDm,
- Paolo Golino, MD, PhDn,
- Paolo Magnavacchi, MD, PhDo,
- Francesco Meucci, MDb,
- Bruno Pezzulich, MDc,
- Miroslava Stolcova, MDa and
- Giuseppe Tarantini, MD, PhDh
- aUOC Cardiologia Diagnostica ed Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy
- bUO Cardiologia Generale, Azienda Ospedaliero-Universitaria di Careggi, Firenze, Italy
- cUO Cardiologia, Maria Pia Hospital, Turin, Italy
- dUO Cardiologia Interventistica ed Emodinamica, Ospedale San Raffaele, Milan, Italy
- eUO Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- fUO Cardiologia, Ospedale Luigi Sacco, Milan, Italy
- gCardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Università di Milan, Milan, Italy
- hDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
- iUO Cardiologia, Maria Eleonora Hospital, Palermo, Italy
- jUOC Cardiologia, ULSS13 Mirano, Mirano, Italy
- kUOS di Servizi Cardiologici, Campus Bio-medico, Rome, Italy
- lDepartment of advanced biomedical sciences, Federico II University, Naples, Italy
- mUSD Cardiologia Interventistica-ASST Ovest Milanese-Ospedale Legnano-Magenta, Legnano, Italy
- nUOC Cardiologia Clinica, Azienda Ospedaliera “Sant’Anna e San Sebastiano” di Caserta, Caserta, Italy
- oUO Cardiologia, Policlinico di Modena–Ospedale di Baggiovara, Modena, Italy
- ↵∗Address for correspondence:
Dr. Sergio Berti, UOC Cardiologia Diagnostica ed Interventistica, Fondazione Toscana Gabriele Monasterio – Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, Italy.
Objectives This study sought to evaluate the feasibility, safety, and efficacy of intracardiac echocardiography (ICE)–guided versus transesophageal echocardiography (TEE)–guided left atrial appendage occlusion (LAAO) by the use of Amplatzer Cardiac Plug or Amulet devices included in a large Italian registry.
Background TEE is widely used for LAAO procedure guidance. ICE may be a potential alternative imaging modality in LAAO.
Methods Data from 604 LAAO procedures performed in 16 Italian centers were reviewed. ICE-guided LAAO was performed in 187 patients, whereas TEE was used in 417 patients. Procedural success was defined as LAAO without occurrence of pericardial tamponade, stroke, systemic embolism with end organ damage, major bleeding, and device embolization. Stroke, transient ischemic attack, major bleeding, overall and cardiovascular death were analyzed.
Results CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65 to 74 years, sex category) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol) scores were similar between the ICE and TEE groups. TEE implied lower procedural (delta 12 min) and fluoroscopy time (delta 5 min) when compared with ICE. Procedural success was similarly high (≥94%) between the TEE and ICE groups with a complication rate of 6.5% for TEE versus 4.2% for ICE (odds ratio: 1.468; 95% confidence interval: 0.681 to 3.166; p = 0.327). At median follow-up of 451 days (interquartile range: 162 to 899 days), the rate of cerebral ischemic events was similar between TEE-guided and ICE-guided procedures.
Conclusions ICE-guided LAAO by means of Amplatzer devices may represent a second alternative imaging modality after an appropriate learning curve and bearing in mind that pre-procedural computed tomography imaging is mandatory. When comparing ICE with TEE, TEE remains the gold standard.
Dr. Berti has served as a proctor for St. Jude Medical and Edwards Lifesciences. Drs. Vignali and Tarantini have served as proctors for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 16, 2018.
- Revision received May 3, 2018.
- Accepted May 3, 2018.
- 2018 American College of Cardiology Foundation