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

Abstract

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