PO-03-165 INTRACARDIAC OR TRANSESOPHAGEAL ECHOCARDIOGRAPHY-GUIDED LEFT ATRIAL APPENDAGE OCCLUSION: CLINICAL PROTOCOL AND OUTCOMES

Abstract

Left atrial appendage occlusion (LAAO) has historically been guided by transesophageal echocardiography (TEE) and fluoroscopy imaging. Intracardiac echocardiography (ICE) has emerged as a safe and feasible alternative to TEE, eliminating the need for general anesthesia. To evaluate the safety and efficacy of a protocol to select TEE or ICE guidance for LAAO procedures. The study population was comprised of all patients undergoing LAAO with the Watchman device (Boston Scientific, Marlborough, MA) from January 2018 to March 2022 at the University of Nebraska Medical Center. Patients with a left atrial appendage thrombus or an anatomical contraindication for device implantation were excluded. A novel protocol (Figure 1) was applied to select TEE or ICE guidance beginning in January 2020. In-hospital outcomes were compared between patients who underwent LAAO with TEE vs. ICE. The composite endpoint of safety and efficacy was defined as device implantation without peri-device leak, freedom from procedural complications, and no need to convert from ICE to TEE guidance. A total of 234 patients were included; the mean age was 76.1±8.27 years old, and 42.3% were female. The mean CHA2DS2-VASc score was 5.1±1.7. ICE guidance was used for 63 procedures; TEE guidance was used for 171 procedures. For the composite outcome, ICE-guided LAAO was superior to TEE-guided LAAO (96.8% vs. 86.5%; p=0.029). In comparison to the TEE-guided LAAO group, the ICE-guided group had shorter procedure times (99.8±30.0 vs. 89.1±26.3 minutes, p=0.0087) and a significantly lower need for general anesthesia (98.8 vs 26.6%, p<0.0001). Utilization of a protocol to select appropriate patients for ICE vs. TEE guidance for LAAO is safe and effective. Use of this protocol resulted in improved outcomes, shorter procedures, and less general anesthesia for ICE-guided procedures compared to TEE-guided procedures.