Let It Go: Intracardiac Echocardiography Is the Future of Imaging for Left Atrial Appendage Occlusion
نویسندگان
چکیده
Feasibility and Safety of Intracardiac Echocardiography Use in Transcatheter Left Atrial Appendage Closure ProceduresJournal the Society for Cardiovascular Angiography & InterventionsVol. 1Issue 6100510PreviewLeft atrial appendage closure (LAAC) is usually performed under guidance transesophageal echocardiography (TEE). Data on safety intracardiac echocardiogram (ICE)–guided LAAC from a real-world population United States remain limited. In this study, aim was to evaluate trends outcomes ICE-guided procedures using US National Inpatient Sample. Full-Text PDF Open Access FACT: No one wants undergo FICTION: occlusion (LAAO) requires TEE. Although LAAO real-time cardiac imaging, (ICE) rapidly emerging as an alternative Effective use ICE thorough understanding its advantages limitations. Rigorous studies are necessary efficacy LAAO. Improved protocols, technology, reimbursement will streamline use. comparison with TEE, offers unique advantages. allows operator control imaging directly, eliminating TEE-associated challenge communication between procedure’s eyes (the imager) hands procedural operator). Moreover, minimally invasive. Without prolonged TEE can be conscious sedation. addition improving patient comfort satisfaction, improves efficiency by time risks associated intubation extubation. This catheterization laboratory throughput facilitates same-day discharge.1Dallan L.A.P. Bezerra H.G. Cochet A. et al.Safety, efficacy, cost-effectiveness discharge left occlusion.J Invasive Cardiol. 2022; 34: E124-E131PubMed Google Scholar Conscious sedation became especially important during COVID-19 pandemic, when both anesthesiologists hospital beds were scarce. contrast 2-dimensional provides only single-plane probe manipulation change views, generates lower far-field image resolution, necessitates dedicated venous access site. we believe that should default modality LAAO, there remains minority cases which may appropriate (Table 1), less experienced users.Table 1Standard protocol indications not guide occlusion.ICE LAAOViewStructures seenMidright atrium anterior view (home view)Right atrium, tricuspid valve, right ventricle, pulmonic aortic valve; assess pericardial effusionRight side interventricular septumLeft ventricle; ventricular function effusionMain pulmonary artery or outflow tractApex appendage; thrombusMidright left/posterior (transseptal view)Interatrial septum atrium; transseptal punctureRetroflexed midleft atriumLeft similar 45° viewProximal superior veinLeft 90° viewRetroflexed + right-steered supramitral viewLeft 135° viewAnteflexed atriumMitral valve effusionIndications (when modality)Concern thrombus (patient preprocedural anticoagulation history thrombus)No (CTA TEE)A GFR <30 mL/min per 1.73 m2 hemodialysis (ICE-guided more than amount used TEE-guided procedures)Complex anatomy (shallow, very large/small, posteriorly directed appendage)CTA, computed tomography angiography; GFR, glomerular filtration rate; ICE, echocardiography; occlusion; echocardiography. table new tab CTA, Despite advantages, underused More robust data confirm The previously published experience consists small single- dual-center studies2Pommier T. Guenancia C. Richard al.Safety ACP Watchman device guided atrium.Clin 2021; 44: 1402-1408https://doi.org/10.1002/clc.23696Crossref PubMed Scopus (1) Scholar; however, issue Journal, Zahid al3Zahid S. Gowda Hashem al.Feasibility transcatheter closure.J Soc Cardiovasc Angio Interv. 1: 100510Google report 1410 identified 61,995 Sample 2015 2019. increased 1.7% 2.2% Patients receiving had baseline comorbidities those guidance; propensity-matched mostly similar, notably including mortality retroperitoneal bleeding. These provide initial multicenter evidence base supporting LAAO; study has considerable limitations because at all granular period preceded broader recent years. A larger contemporary retrospective set expected SURPASS analysis Registry registry, registry includes commercial States. Ultimately, prospective—preferably randomized—data gold standard, hope see future randomized controlled trial comparing ICE- procedures. Furthermore, bolstered standardization improvements technology reimbursement. standardized exclude effusion (LAA) thrombus, puncture, measure LAA multiple angles, postprocedural effusion. Our standard provided Table 1. 2021 expert consensus document further describes how obtain optimal views LAA.4Berti Pastormerlo L.E. Korsholm K. al.Intracardiac occlusion: document.Catheter 98: 815-825https://doi.org/10.1002/ccd.29791Crossref (6) advent 3-dimensional (3D)-ICE expands capabilities LAAO.5Alkhouli M. Simard El Shaer al.First novel live 3D catheter structural heart interventions.JACC Imaging. 15: 1502-1509https://doi.org/10.1016/j.jcmg.2021.09.015Crossref (0) images visually appealing, key innovation 3D-ICE ability rotate plane digitally, full 360° visualization LAA. digital rotation capability permits numerous measurements inspection implanted before release without need excessive maneuvering atrium. 2022, American Medical Association’s Current Procedural Terminology Panel Center Medicare Medicaid Services added (33340) list primary add-on code (+93662) billed; intraprocedural significantly bill code. For become routine care must catch up. particular, stand-alone made available cover services physician technologist manage console, controlling labor-intensive interface. conclusion, guidance. have begun demonstrate Evolving help systematize ICE. Given these many merits community embrace ascendant coming years, undoubtedly continue increase rapidly; Elsa (Idina Menzel) sings Disney’s Frozen, “Let it go, let can’t hold back anymore!” Dr Goldsweig reports speaking fees Philips consulting Inari Medical. Alkhouli serving advisory boards institutional research grant support Boston Scientific Abbott Biosense Webster.
منابع مشابه
A Semi-Automated Algorithm for Segmentation of the Left Atrial Appendage Landing Zone: Application in Left Atrial Appendage Occlusion Procedures
Background: Mechanical occlusion of the Left atrial appendage (LAA) using a purpose-built device has emerged as an effective prophylactic treatment in patients with atrial fibrillation at risk of stroke and a contraindication for anticoagulation. A crucial step in procedural planning is the choice of the device size. This is currently based on the manual analysis of the “Device Landing Zone” fr...
متن کاملThe role of echocardiography in percutaneous left atrial appendage occlusion.
Percutaneous device closure of the left atrial appendage (LAA) has been introduced in the last decade as a minimally invasive alternative treatment to long-term anticoagulation to reduce the risk of thrombo-embolism in patients with atrial fibrillation. Echocardiography is an essential tool at all stages of the procedure. Pre-procedural echocardiography is used to screen suitable candidates and...
متن کاملImaging the left atrial appendage with intracardiac echocardiography: leveling the playing field.
Amid the boundless scientific discovery of the mid-19th century, Henry David Thoreau reflected, “The question is not what you look at, but what you see.” Scientific discovery emerges from novel perspectives on commonly observed phenomena. To truly “see” in the scientific sense, we must approach questions using the proper point of view. In this context, perspective is at least twice as important...
متن کاملLeft Atrial Appendage Occlusion
Left atrial appendage (LAA) occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC), it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC) and mitral valve replacement (MVR) too. Nowadays, PTMC is perfor...
متن کاملCatheter-based left atrial appendage occlusion procedure: role of echocardiography.
Atrial fibrillation is a common, clinically significant arrhythmic disorder that results in increased risk of morbidity and mortality in affected patients. Atrial fibrillation is more prevalent among men compared with women and the risk for developing atrial fibrillation increases with advancing age. Ischaemic stroke is the most common clinical manifestation of embolic events from atrial fibril...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
ژورنال
عنوان ژورنال: Journal of the Society for Cardiovascular Angiography & Interventions
سال: 2022
ISSN: ['2772-9303']
DOI: https://doi.org/10.1016/j.jscai.2022.100518