Left atrial appendage closure monitoring without sedation: a pilot study using intracardiac echocardiography through the oesophageal route.

Abstract

Aims: We evaluated the safety and feasibility of an intracardiac echocardiography probe through the oesophageal route (ICE-TEE) for the monitoring of left atrial appendage (LAA) closure to avoid general anaesthesia. Methods and results: The study included 16 consecutive patients (75±7 years) in atrial fibrillation with high embolism (CHADS-VASc=5±1.4) and bleeding risk (HAS-BLED=4±0.9) referred for LAA closure (Amplatzer Cardiac Plug [ACP]). Standard TEE was performed before device implantation for LAA analysis. During the procedure, ICE-TEE was used under local anaesthesia to determine LAA size and monitor ACP positioning. Maximum and minimum LAA diameter by standard TEE averaged 21±3 mm and 18±1 mm, respectively. Eccentricity index (1.1±0.2) increased with LAA diameter (r=0.73, p=0.001). Maximum LAA size (21±3 mm) obtained by ICE-TEE during the procedure closely correlated with standard TEE measurement (r=0.9, p<0.0001). LAA closure was successfully performed in 15 patients without complication (one failed despite testing three ACP). Implanted ACP size averaged 25±3 mm (range 22-30 mm) and correlated with the size predicted by ICE-TEE (r=0.89) and standard TEE (r=0.57). Procedure duration (62±27 min) correlated with LAA size by ICE-TEE (r=0.71, p=0.002) and eccentricity index (r=0.58, p=0.02). Conclusions: An ICE-TEE probe through the oesophageal route without general anaesthesia may be used for the monitoring of ACP device implantation.