Abstract
Left atrial appendage occlusion (LAAO) has historically been performed with general anesthesia and transesophageal echocardiography (TEE). Recently, intracardiac echocardiography (ICE) has been described for LAAO. This approach facilitates the use of monitored anesthesia care (MAC) instead of endotracheal intubation and general anesthesia. We describe the use, safety, and efficacy of MAC vs. general anesthesia for LAAO using ICE. We retrospectively reviewed 57 patients who underwent LAAO using ICE at our institution from 2019 to 2021. General anesthesia and MAC were performed at the multidisciplinary team’s (EP and cardiac anesthesia) discretion using standard procedures. We compared baseline demographics, periprocedural data, and procedural outcomes between both groups. Continuous variables were expressed as mean and standard deviation if normally distributed and median and interquartile range if non-normally distributed. Continuous variables were compared using the Student’s t test or the non-parametric equivalent and categorical variables were compared using the chi square test. A p value of <0.05 was considered statistically significant. 16 patients were treated with MAC while 41 patients were treated with general anesthesia. There were no significant differences in baseline demographics between both groups. There were no differences in percentage of successful implants or procedure length. There were no major complications in either group. Notably, length of stay (LOS) was significantly lower in conscious sedation when compared to general anesthesia. Results are summarized in Table 1. MAC is safe and feasible in LAAO using ICE. MAC can decrease LOS and avoid potential risks of endotracheal intubation without increase in procedural complications or costs. Further investigation is required to compare between both techniques.
Published Version
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