PO-03-193 SINGLE CENTER EXPERIENCE OF TRANSITIONING FROM TRANSESOPHAGEAL TO INTRACARDIAC ECHOCARDIOGRAPHY FOR LEFT ATRIAL APPENDAGE CLOSURE

Abstract

Left atrial appendage closure (LAAC) is typically performed under peri-procedural transesophageal (TEE) guidance with general anesthesia. LAA closure guided by intracardiac echo (ICE) imaging in the LA is emerging, can provide excellent imaging and allows the implant to be done under moderate sedation/monitored anesthesia, but requires a learning curve. To compare the outcomes of LAAC with TEE only vs a transition phase using both TEE and ICE vs ICE only. Consecutive patients undergoing LAAC with Watchman FLXTM implantation from August 2020 to November 2022 were included in the study. The patient population was divided in three groups based on utilization of TEE only (group 1), TEE + ICE (group 2) and ICE only (Group 3). Group 2 represent the transitioning phase where the institution adapted ICE as standard of care while TEE was used for confirmation as learning curve for the operator. Outcomes of implantation success, procedural times, adverse events, and discontinuation of OAC at 45 days were assessed. Mean age of cohort was 74 +/- 8 with 54 % males. Average CHA2DS2VASc score was 4.02 +/- 1.2. The transition phase (TEE+ICE) was 90 days. A total of 155 patients underwent LAAC with Watchman FLX [group 1=62, group 2=15 and group 3= 78]. Procedural success was achieved in 93.5%, 94.7% and 97.2% in group 1, group 2 and group 3 respectively. Procedure times with ICE only was comparable to TEE only group. There were no differences with average devices used per implant. No major adverse events were noted. At 45 days there was no difference in incidence of PDL. [Table] LAAC under ICE offers comparable outcomes as TEE without requiring general anesthesia.