Clinical Results and Safety of Intracardiac Echocardiography Guidance for Combined Catheter Ablation and Left Atrial Appendage Occlusion

TL;DR

This study shows that using ICE guidance for a combined heart procedure is as safe as TEE and reduces procedure time and radiation exposure.

Contribution

Demonstrates ICE guidance is non-inferior to TEE for combined ablation and LAAO, with added procedural benefits.

Findings

ICE guidance reduced procedural duration, fluoroscopy time, and contrast use compared to TEE.

Both ICE and TEE groups had similar safety outcomes, including low rates of complications and device-related issues.

LAA velocity was found to correlate with the risk of peri-device leaks.

Abstract

The goal of this study was to compare the procedural safety
and long-term outcome associated with a combined catheter ablation and left
atrial appendage occlusion (LAAO) procedure utilizing intracardiac
echocardiography (ICE) guidance versus transesophageal echocardiography (TEE)
guidance. The study focuses on implementing LAmbre and Watchman devices in
patients diagnosed with nonvalvular atrial fibrillation (AF).

A total of 363 patients diagnosed with nonvalvular AF and
who underwent a combined procedure were prospectively enrolled between November
2017 and May 2022. Following 1:1 propensity score matching, the TEE group (n =
132) and ICE group (n = 132) were systematically compared in terms of the
combined procedure, imaging parameters, events related to the procedure, and
subsequent outcomes during follow-up, including mortality, stroke, bleeding,
device-related thrombus (DRT), and peri-device leaks (PDLs).

The ICE group exhibited a significant reduction in total procedural duration
(153.71 ± 31.71 vs. 174.74 ± 18.79 min), fluoroscopy radiation dosage
(207.24 ± 108.39 vs. 268.61 ± 122.88 mGy), left atrial appendage
occlusion procedure time (34.69 ± 10.91 vs. 51.46 ± 15.84 min), and
contrast agent exposure (108.71 ± 37.59 vs. 158.41 ± 45.00 mL)
compared to the TEE group. Angiography and ICE demonstrated a substantial
correlation between the left atrial appendage (LAA) orifice and landing zone/LAA
ostium (Pearson’s correlation coefficient r = 0.808 and 0.536/0.697, two-tailed
p
< 0.001). No occurrences of device-related embolism,
thromboembolism, significant bleeding, or unexpected fatalities were observed in
either group. Comparable rates of all-cause death (0.76% vs. 0.76%), stroke or
transient ischemic attack (2.27% vs. 1.52%), severe bleeding (1.52% vs.
0.76%), PDL (23.81% vs. 24.62%), and DRT (1.52% vs. 1.52%) were noted after
an average follow-up of 18.46 ± 7.70 months in both groups, with no
discernible differences. Multivariate logistic regression analysis identified a
correlation between LAA velocity and the risk of PDL.

The
effectiveness and safety of ICE-guided combined treatment were demonstrated to be
comparable to TEE guidance, accompanied by the additional advantages of decreased
procedure time and fluoroscopy radiation exposure.

NCT04391504, https://register.clinicaltrials.gov.

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