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Single trans‐septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure
Author(s) -
Aguirre Daniel,
Pincetti Christian,
Perez Luis,
Deck Carlos,
Alfaro Mario,
Vergara Maria Jesus,
Maluenda Gabriel
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27246
Subject(s) - medicine , transesophageal echocardiogram , atrial fibrillation , thrombus , cardiology , stroke (engine) , left atrial appendage occlusion , surgery , embolization , occlusion , intracardiac injection , catheter , warfarin , mechanical engineering , engineering
Objective This registry aimed to describe the safety and feasibility of a single trans‐septal (TS) access technique for left intracardiac echocardiography (ICE) guidance of left‐atrial appendage (LAA) closure procedure. Background LAA closure is currently accepted as an alternative to oral anticoagulation (OAC) in patients with non‐valvular atrial fibrillation (NVAF) who are at high‐risk for bleeding. Currently, LAA closure procedure is typically performed under trans‐esophageal echocardiogram (TEE) guidance. Although, ICE has the advantage of not requiring profound sedation/anesthesia, ICE‐LAA imaging quality is often limited from the right atrium requiring double TS access. Methods Twenty‐two patients with NVAF underwent LAA closure using the Amplatzer Amulet™ device (St Jude Medical) under ICE guidance from the left atrium. The ICE AcuNav catheter (Biosense Webster) and the Amulet delivery sheath were advanced into the LA through single TS puncture technique. Results The population was predominately male (59.1%) with a mean age of 74 ± 9.3 years, at high‐risk for stroke (mean CHADS2 score of 3.8 ± 1.1) and bleeding (mean HAS BLED score of 3.5 ± 1.3). The Amplatzer Amulet TM device was successfully implanted in all patients. No procedural related complications including device embolization were noted. No major cardiovascular events occurred and all patients were discharged alive. At 30‐day follow‐up all patients remained alive, free of ischemic stroke and with no residual leak or device thrombus on TEE. Conclusions This initial experience suggests that LAA occlusion with the Amplatzer Amulet device using ICE guidance from the left atrium via a single trans‐septal technique is feasible and safe.