PO-01-022 UTILIZATION OF INTRACARDIAC ECHOCARDIOGRAM DURING LEFT ATRIAL APPENDAGE OCCLUSION: EVALUATION OF CARE UTILIZATION

Abstract

Left Atrial Appendage Occlusion (LAAO) has emerged as a safe alternative for patients with nonvalvular atrial fibrillation at risk for bleeding. Transesophageal echocardiography (TEE) has been the gold-standard in guiding implantation and pre- and post-operative assessment of device location, compression, and stability. The intracardiac echocardiogram (ICE) catheter can also be used to provide imaging guidance during transseptal access and device deployment during LAAO, thus providing an alternative to TEE and general anesthesia (GA). To review the anesthesia requirements, procedural efficiency, and hospital length of stay for patients who underwent ICE guided (IG) vs TEE-guided (TG) LAAO. This is a retrospective observational study including patients who underwent LAAO between Nov 2020 and Nov 2022 at a single center, with 4 operators. Variables analyzed included imaging guidance, procedural success, anesthesia requirements, length of stay, and clinical outcomes. Chi squared and multivariate t-test were used to evaluate differences between the groups. Of the total 120 patients that underwent LAAO during this period, 64 were performed with IG and 56 were performed with TG. Baseline characteristics were similar between the groups (Table 1). Among those patients who had IG, 47(73%) had monitored anesthesia (MAC) and 17(27%) had GA as compared to 2(4%) with MAC and 54(96%) with GA in the TG group (P<0.0001). Total time in the EP lab and total fluoroscopy time were similar between the groups (Table 1). Acute procedural success was similar, 98% in the IG group, and 96% in the TG group (P= 0.9471). Same day discharge was successful in 22(34%) in the IG group as compared to 17(30%) in the TG group (P= 0.639). There was no statistically significant difference in peri-device leak among the two groups during follow up imaging regardless of the type of follow up imaging modality (Figure 1). Our results revealed no statistically significant difference in outcomes between IG and TE LAAO. Therefore, this study highlights IG LAAO as an alternative with periprocedural and long-term outcomes equivalent to TG LAAO. Utilizing ICE for LAAO significantly reduces anesthetic requirements while maintaining procedural efficiency, safety, and procedural success. Consequently, the implementation of IG LAAO could increase the volume capacity of electrophysiology labs that are currently limited due to anesthesiologist availability.Tabled 1Table 1VariableIce-GuidedTEE-GuidedP-valueAge76.475.90.7539CHADS2Vasc4.44.20.5551LVEF58530.0763Pre-procedure CT scan6242<0.0001Monitored Anesthesia472<0.0001General Anesthesia1754<0.0001Acute procedural success63520.9471Total time in EP lab (minutes)1301280.86Total fluoroscopy (minutes)1413.80.8796 Open table in a new tab