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Current Cardiology Reports

Erschienen in:

23.08.2023 | Structural Heart Disease (S Vakamudi, Section Editor)

The Emerging Role of Intracardiac Echocardiography (ICE) in Left Atrial Appendage Closure (LAAC)

verfasst von: Aravdeep Jhand, Andrew M. Goldsweig

Erschienen in: Current Cardiology Reports | Ausgabe 10/2023

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Abstract

Purpose of Review

Intracardiac echocardiography (ICE) has emerged as a powerful imaging tool to guide percutaneous left atrial appendage closure (LAAC). Herein, we review an imaging protocol for ICE-guided LAAC and discuss the evidence for its use.

Recent Findings

Standardized imaging protocols have been proposed but have not been fully validated. ICE imaging yields similar procedural and clinical outcomes when compared to transesophageal echocardiography (TEE) to guide LAAC. Despite benefits of avoiding general anesthesia, TEE, and multiple physicians for LAAC procedures, ICE imaging remains under-utilized. Novel ICE catheters with 3D imaging capabilities may improve accuracy and efficiency of LAAC device implantation.

Summary

ICE guidance is feasible, safe, and effective for LAAC. As the field evolves, further studies will be necessary to assess this technological advancement in imaging guidance.

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Kornej J, Benjamin EJ, Magnani JW. Atrial fibrillation: global burdens and global opportunities. Heart. 2021;107(7):516–8. https://doi.org/10.1136/heartjnl-2020-318480.CrossRef

Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010.CrossRefPubMedPubMedCentral

Alkhouli M, Noseworthy PA, Rihal CS, Holmes DR. Stroke prevention in nonvalvular atrial fibrillation: a stakeholder perspective. J Am Coll Cardiol. 2018;71(24):2790–801. https://doi.org/10.1016/j.jacc.2018.04.013.CrossRefPubMed

Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, et al. European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. EP Europace. 2021;23(10):1612–76. https://doi.org/10.1093/europace/euab065.CrossRef

Hsu JC, Maddox TM, Kennedy KF, Katz DF, Marzec LN, Lubitz SA, et al. Oral anticoagulant therapy prescription in patients with atrial fibrillation across the spectrum of stroke risk: insights from the NCDR PINNACLE Registry. JAMA Cardiol. 2016;1(1):55–62. https://doi.org/10.1001/jamacardio.2015.0374.CrossRefPubMed

Pokorney SD, Gersh BJ, Ahmad A, Al-Khatib SM, Blank M, Coylewright M, et al. Stroke prevention in atrial fibrillation: closing the gap. Am Heart J. 2019;210:29–38. https://doi.org/10.1016/j.ahj.2018.10.004.CrossRefPubMed

Holmes DR, Alkhouli M, Reddy V. Left atrial appendage occlusion for the unmet clinical needs of stroke prevention in nonvalvular atrial fibrillation. Mayo Clin Proc. 2019;94(5):864–74. https://doi.org/10.1016/j.mayocp.2018.09.025.CrossRefPubMed

January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the society of thoracic surgeons. Circulation. 2019;140(2):e125–51. https://doi.org/10.1161/CIR.0000000000000665.CrossRefPubMed

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2020;42(5):373–498. https://doi.org/10.1093/eurheartj/ehaa612.CrossRef

10.

Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. The Lancet. 2009;374(9689):534–42. https://doi.org/10.1016/S0140-6736(09)61343-X.CrossRef

11.

Holmes DR, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, et al. Prospective randomized evaluation of the Watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014;64(1):1–12. https://doi.org/10.1016/j.jacc.2014.04.029.CrossRefPubMed

12.

Lakkireddy D, Thaler D, Ellis CR, Swarup V, Sondergaard L, Carroll J, et al. Amplatzer amulet left atrial appendage occluder versus Watchman device for stroke prophylaxis (amulet IDE): a randomized, controlled trial. Circulation. 2021;144(19):1543–52. https://doi.org/10.1161/CIRCULATIONAHA.121.057063.CrossRefPubMedPubMedCentral

13.

Ramchand J, Harb SC, Miyasaka R, Kanj M, Saliba W, Jaber WA. Imaging for percutaneous left atrial appendage closure: a contemporary review. Structural Heart. 2019;3(5):364–82. https://doi.org/10.1080/24748706.2019.1643957.CrossRef

14.

Korsholm K, Berti S, Iriart X, Saw J, Wang DD, Cochet H, et al. Expert recommendations on cardiac computed tomography for planning transcatheter left atrial appendage occlusion. JACC: Cardiovasc Interv. 2020;13(3):277–92. https://doi.org/10.1016/j.jcin.2019.08.054.

15.

So Cy, Kang G, Villablanca PA, Ignatius A, Asghar S, Dhillon D, et al. Additive value of preprocedural computed tomography planning versus stand‐alone transesophageal echocardiogram guidance to left atrial appendage occlusion: comparison of real‐world practice. J Am Heart Assoc. 2021;10(17):e020615. https://doi.org/10.1161/JAHA.120.020615.

16.

Saw J, Fahmy P, Spencer R, Prakash R, McLaughlin P, Nicolaou S, et al. Comparing measurements of CT angiography, TEE, and fluoroscopy of the left atrial appendage for percutaneous closure. J Cardiovasc Electrophysiol. 2016;27(4):414–22. https://doi.org/10.1111/jce.12909.CrossRefPubMed

17.

Agmon Y, Khandheria BK, Gentile F, Seward JB. Echocardiographic assessment of the left atrial appendage. J Am Coll Cardiol. 1999;34(7):1867–77. https://doi.org/10.1016/S0735-1097(99)00472-6.CrossRefPubMed

18.

Hahn RT, Saric M, Faletra FF, Garg R, Gillam LD, Horton K, et al. Recommended standards for the performance of transesophageal echocardiographic screening for structural heart intervention: from the American Society of Echocardiography. J Am Soc Echocardiogr. 2022;35(1):1–76. https://doi.org/10.1016/j.echo.2021.07.006.CrossRefPubMed

19.

Alkhouli M, Rihal CS, Holmes DR. Transseptal techniques for emerging structural heart interventions. JACC: Cardiovasc Interv. 2016;9(24):2465–80. https://doi.org/10.1016/j.jcin.2016.10.035.

20.

Qamar RS, Jalal S, Nicolaou S, Tsang M, Gilhofer T, Saw J. Comparison of cardiac computed tomography angiography and transoesophageal echocardiography for device surveillance after left atrial appendage closure. EuroIntervention. 2019;15(8):663–70.CrossRefPubMed

21.

Korsholm K, Jensen JM, Nørgaard BL, Nielsen-Kudsk JE. Detection of device-related thrombosis following left atrial appendage occlusion. Circulation: Cardiovasc Interv. 2019;12(9):e008112. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008112.

22.

Saw J, Fahmy P, DeJong P, Lempereur M, Spencer R, Tsang M, et al. Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure. European Heart Journal - Cardiovascular Imaging. 2015;16(11):1198–206. https://doi.org/10.1093/ehjci/jev067.CrossRefPubMedPubMedCentral

23.

•• Saw J, Holmes DR, Cavalcante JL, Freeman JV, Goldsweig AM, Kavinsky CJ, et al. SCAI/HRS expert consensus statement on transcatheter left atrial appendage closure. J Soc Cardiovasc Angiography Interv. 2023;2(3). https://doi.org/10.1016/j.jscai.2022.100577. This updated consensus document provides recommendations on contemporary, evidence-based best practices including intraprocedural imaging for transcatheter left atrial appendage closure.

24.

Alkhouli M, Nielsen-Kudsk JE. The case for intracardiac echo to guide left atrial appendage closure. Interventional Cardiology Clinics. 2022;11(2):153–8. https://doi.org/10.1016/j.iccl.2021.11.007.CrossRefPubMed

25.

Wass SY, Galo J, Yoon S-H, Dallan LAP, Mogalapalli A, Ukaigwe A, et al. Predictors of successful same-day discharge and 1-year outcomes after left atrial appendage closure. Catheter Cardiovasc Interv. 2022;100(7):1307–13. https://doi.org/10.1002/ccd.30464.CrossRefPubMed

26.

Goldsweig AM, Alkhouli M. Let it go: intracardiac echocardiography is the future of imaging for left atrial appendage occlusion. J Soc Cardiovasc Angiography Interv. 2022;1(6). https://doi.org/10.1016/j.jscai.2022.100518.

27.

Alkhouli M, Ellis CR, Daniels M, Coylewright M, Nielsen-Kudsk JE, Holmes DR. Left atrial appendage occlusion. JACC: Advances. 2022;1(5):100136. https://doi.org/10.1016/j.jacadv.2022.100136.

28.

MacDonald ST, Newton JD, Ormerod OJ. Intracardiac echocardiography off piste? Closure of the left atrial appendage using ICE and local anesthesia. Catheter Cardiovasc Interv. 2011;77(1):124–7. https://doi.org/10.1002/ccd.22652.CrossRefPubMed

29.

Jhand A, Thandra A, Gwon Y, Turagam MK, Ashwath M, Yadav P, et al. Intracardiac echocardiography versus transesophageal echocardiography for left atrial appendage closure: an updated meta-analysis and systematic review. Am J Cardiovasc Dis. 2020;10(5):538–47.PubMedPubMedCentral

30.

Hemam ME, Kuroki K, Schurmann PA, Dave AS, Rodríguez DA, Sáenz LC, et al. Left atrial appendage closure with the Watchman device using intracardiac vs transesophageal echocardiography: procedural and cost considerations. Heart Rhythm. 2019;16(3):334–42. https://doi.org/10.1016/j.hrthm.2018.12.013.CrossRefPubMedPubMedCentral

31.

Freitas-Ferraz AB, Bernier M, Vaillancourt R, Ugalde PA, Nicodème F, Paradis J-M, et al. Safety of transesophageal echocardiography to guide structural cardiac interventions. J Am Coll Cardiol. 2020;75(25):3164–73. https://doi.org/10.1016/j.jacc.2020.04.069.CrossRefPubMed

32.

Munir MB, Khan MZ, Darden D, Pasupula DK, Balla S, Han FT, et al. Contemporary procedural trends of Watchman percutaneous left atrial appendage occlusion in the United States. J Cardiovasc Electrophysiol. 2021;32(1):83–92. https://doi.org/10.1111/jce.14804.CrossRefPubMed

33.

Zahid S, Gowda S, Hashem A, Khan MZ, Ullah W, Kaur G, et al. Feasibility and safety of intracardiac echocardiography use in transcatheter left atrial appendage closure procedures. J Soc Cardiovasc Angiography Interv. 2022;1(6). https://doi.org/10.1016/j.jscai.2022.100510.

34.

Galea R, Marco FD, Meneveau N, Aminian A, Anselme F, Gräni C, et al. Amulet or Watchman device for percutaneous left atrial appendage closure: primary results of the SWISS-APERO randomized clinical trial. Circulation. 2022;145(10):724–38. https://doi.org/10.1161/CIRCULATIONAHA.121.057859.CrossRefPubMed

35.

Sharma A, Bertog S, Tholakanahalli V, Mbai M, Chandrashekhar YS. 4D intracardiac echocardiography-guided LA appendage closure under conscious sedation. JACC: Cardiovasc Imaging. 2021;14(11):2254–9. https://doi.org/10.1016/j.jcmg.2020.09.025.

36.

Ranard LS, Khalique OK, Donald E, Agarwal V, Hamid N, Hahn RT, et al. Transcatheter left atrial appendage closure using preprocedural computed tomography and intraprocedural 4-dimensional intracardiac echocardiography. Circ Cardiovasc Interv. 2021;14(7):e010686. https://doi.org/10.1161/CIRCINTERVENTIONS.121.010686.

37.

• Berti S, Pastormerlo LE, Korsholm K, Saw J, Alkhouli M, Costa MP, et al. Intracardiac echocardiography for guidance of transcatheter left atrial appendage occlusion: an expert consensus document. Catheter Cardiovasc Interv. 2021;98(4):815–25. https://doi.org/10.1002/ccd.29791. This expert consensus document provides a protocol for use of intracardiac echocardiography in guiding left atrial appendage closure.CrossRefPubMed

38.

Alkhouli M, Simard T, Killu AM, Friedman PA, Padang R. First-in-human use of a novel live 3D intracardiac echo probe to guide left atrial appendage closure. JACC: Cardiovasc Interv. 2021;14(21):2407–9. https://doi.org/10.1016/j.jcin.2021.07.024.

39.

Paiva LV, Costa MP, Barra SC, Gonçalves L. Intracardiac echography for left atrial appendage closure: a step-by-step tutorial. Catheter Cardiovasc Interv. 2019;93(5):E302–10. https://doi.org/10.1002/ccd.27898.CrossRefPubMed

40.

Enriquez A, Saenz LC, Rosso R, Silvestry FE, Callans D, Marchlinski FE, et al. Use of intracardiac echocardiography in interventional cardiology. Circulation. 2018;137(21):2278–94. https://doi.org/10.1161/CIRCULATIONAHA.117.031343.CrossRefPubMed

41.

Vanhaverbeke M, Nuyens P, Bieliauskas G, Sondergaard L, Vejlstrup N, De Backer O. Facilitation techniques to cross the interatrial septum with intracardiac echocardiography during left atrial appendage closure. Catheter Cardiovasc Interv. 2022;100(5):795–800. https://doi.org/10.1002/ccd.30348.CrossRefPubMedPubMedCentral

42.

Korsholm K, Jensen JM, Nielsen-Kudsk JE. Intracardiac echocardiography from the left atrium for procedural guidance of transcatheter left atrial appendage occlusion. JACC: Cardiovasc Interv. 2017;10(21):2198–206. https://doi.org/10.1016/j.jcin.2017.06.057.

43.

• Nielsen-Kudsk JE, Berti S, Caprioglio F, Ronco F, Arzamendi D, Betts T, et al. Intracardiac echocardiography to guide Watchman FLX implantation. JACC: Cardiovasc Interv. 2023;16(6):643–51. https://doi.org/10.1016/j.jcin.2022.10.024. This is the first study to prospectively evaluate safety and efficacy of intracardiac echocardiography guided left atrial appendage closure using independent adjudication of echocardiography data by a core lab, and clinical events by a clinical events committee.

44.

Patel A, Venkataraman R, Schurmann P, Dave A, Valderrábano M. Left atrial appendage occlusion using intracardiac echocardiography. Heart Rhythm. 2021;18(2):313–7. https://doi.org/10.1016/j.hrthm.2020.09.021.CrossRefPubMed

45.

Berti S, Paradossi U, Meucci F, Trianni G, Tzikas A, Rezzaghi M, et al. Periprocedural intracardiac echocardiography for left atrial appendage closure: a dual-center experience. JACC: Cardiovasc Interv. 2014;7(9):1036–44. https://doi.org/10.1016/j.jcin.2014.04.014.

46.

Masson J-B, Kouz R, Riahi M, Nguyen Thanh HK, Potvin J, Naim C, et al. Transcatheter left atrial appendage closure using intracardiac echocardiographic guidance from the left atrium. Can J Cardiol. 2015;31(12):1497.e7–.e14. https://doi.org/10.1016/j.cjca.2015.04.031.

47.

Korsholm K, Samaras A, Andersen A, Jensen JM, Nielsen-Kudsk JE. The Watchman FLX device. JACC: Clin Electrophysiol. 2020;6(13):1633–42. https://doi.org/10.1016/j.jacep.2020.06.028.

48.

Turagam MK, Neuzil P, Petru J, Hala P, Mraz T, Baroch J, et al. Intracardiac echocardiography-guided implantation of the Watchman FLX left atrial appendage closure device. J Cardiovasc Electrophysiol. 2021;32(3):717–25. https://doi.org/10.1111/jce.14927.CrossRefPubMed

49.

Berti S, Pastormerlo LE, Santoro G, Brscic E, Montorfano M, Vignali L, et al. Intracardiac versus transesophageal echocardiographic guidance for left atrial appendage occlusion: the LAAO Italian multicenter registry. JACC: Cardiovasc Interv. 2018;11(11):1086–92. https://doi.org/10.1016/j.jcin.2018.05.008.

50.

Nielsen-Kudsk JE, Berti S, De Backer O, Aguirre D, Fassini G, Cruz-Gonzalez I, et al. Use of intracardiac compared with transesophageal echocardiography for left atrial appendage occlusion in the amulet observational study. JACC: Cardiovasc Interv. 2019;12(11):1030–9. https://doi.org/10.1016/j.jcin.2019.04.035.

51.

Alkhouli M, Chaker Z, Alqahtani F, Raslan S, Raybuck B. Outcomes of routine intracardiac echocardiography to guide left atrial appendage occlusion. JACC: Clin Electrophysiol. 2020;6(4):393–400. https://doi.org/10.1016/j.jacep.2019.11.014.

52.

Kar S, Doshi SK, Sadhu A, Horton R, Osorio J, Ellis C, et al. Primary outcome evaluation of a next-generation left atrial appendage closure device. Circulation. 2021;143(18):1754–62. https://doi.org/10.1161/CIRCULATIONAHA.120.050117.CrossRefPubMed

53.

Alkhouli M. The ICE. LAA Study JACC: Cardiovascular interventions. 2023;16(6):652–4. https://doi.org/10.1016/j.jcin.2022.10.012.CrossRefPubMed

54.

Frangieh AH, Alibegovic J, Templin C, Gaemperli O, Obeid S, Manka R, et al. Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman. Catheter Cardiovasc Interv. 2017;90(2):331–8. https://doi.org/10.1002/ccd.26805.CrossRefPubMed

55.

Kim DY, Shin SY, Kim J-S, Kim SH, Kim Y-H, Lim HE. Feasibility of intracardiac echocardiography imaging from the left superior pulmonary vein for left atrial appendage occlusion. Int J Cardiovasc Imaging. 2018;34(10):1571–9. https://doi.org/10.1007/s10554-018-1374-5.CrossRefPubMed

56.

Gianni C, Horton RP, Della Rocca DG, Mohanty S, Al-Ahmad A, Bassiouny MA, et al. Intracardiac echocardiography- versus transesophageal echocardiography-guided left atrial appendage occlusion with Watchman FLX. J Cardiovasc Electrophysiol. 2021;32(10):2781–4. https://doi.org/10.1111/jce.15220.CrossRefPubMed

Titel: The Emerging Role of Intracardiac Echocardiography (ICE) in Left Atrial Appendage Closure (LAAC)
verfasst von: Aravdeep Jhand
Andrew M. Goldsweig
Publikationsdatum: 23.08.2023
Verlag: Springer US
Erschienen in: Current Cardiology Reports / Ausgabe 10/2023
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-023-01940-4

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The Emerging Role of Intracardiac Echocardiography (ICE) in Left Atrial Appendage Closure (LAAC)

Abstract

Purpose of Review

Recent Findings

Summary

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