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. 2022 Nov 3;1(6):100510.
doi: 10.1016/j.jscai.2022.100510. eCollection 2022 Nov-Dec.

Feasibility and Safety of Intracardiac Echocardiography Use in Transcatheter Left Atrial Appendage Closure Procedures

Salman Zahid  1 , Smitha Gowda  2 , Anas Hashem  1 , Muhammad Zia Khan  3 , Waqas Ullah  4 , Gurleen Kaur  5 , Usama Nasir  6 , Devesh Rai  1 , Nadeen N Faza  2 , Stephen H Little  2 , Miguel Valderrabano  2 , Sachin S Goel  2
Affiliations

Feasibility and Safety of Intracardiac Echocardiography Use in Transcatheter Left Atrial Appendage Closure Procedures

Salman Zahid et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Left atrial appendage closure (LAAC) is usually performed under the guidance of transesophageal echocardiography (TEE). Data on the safety of intracardiac echocardiogram (ICE)-guided LAAC from a real-world population in the United States remain limited. In this study, the aim was to evaluate the trends and outcomes of ICE-guided LAAC procedures using the US National Inpatient Sample.

Methods: This study used the National Inpatient Sample database from quarter 4 of 2015 to 2019. We used a propensity-matched analysis and adjusted odds ratios for in-hospital outcomes/complications. A P value of <.05 was considered significant.

Results: We identified 61,995 weighted LAAC cases. Of these, 1410 patients had ICE-guided LAAC with a lower median age than the patients who had TEE-guided LAAC (75 vs 77 years; P ≤ .01). The use of ICE-guided LAAC increased from 1.7% in 2015 to 2.2% in 2019 (P trend = .75). Major, cardiovascular, neurologic, and pulmonary complications were similar for ICE-guided and TEE-guided LAAC on adjusted analysis. On propensity-matched analysis, the overall vascular complication rates were similar. However, retroperitoneal bleeding remained significantly higher (0.7% vs 0%) with ICE. Gastrointestinal bleeding complications were more frequent in TEE-guided LAAC (3.5% vs 2.1%). The length of stay was similar for both groups (median = 1 day; P = .23); however, ICE was associated with $1769 excess cost of hospitalization ($25,112 vs $23,343; P = .04).

Conclusions: ICE-guided LAAC is safer than TEE-guided LAAC, with similar rates of major complications. However, ICE use was associated with lower rates of gastrointestinal bleeding and higher rates of retroperitoneal bleeding. In addition, ICE-guided LAAC is associated with a similar length of stay but higher costs of hospitalization.

Keywords: echocardiography; intracardiac echocardiography; left atrial appendage closure.

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Figures

Figure 1
Figure 1
Study flow chart. ICD-10, International Classification of Diseases, Tenth Revision; ICE, intracardiac echocardiography; LAAC, left atrial appendage closure; Q4, quarter 4; TEE, transesophageal echocardiography.
Central Illustration
Central Illustration
Safety of ICE in transcatheter LAAC: NIS (2015-2019). ICE, intracardiac echocardiography; LAAC, left atrial appendage closure; NIS, National Inpatient Sample; TEE, transesophageal echocardiography.
Figure 2
Figure 2
Balance of covariates before and after propensity matching. CAD, coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; PVD, peripheral vascular disease.
Figure 3
Figure 3
Trend of ICE use for left atrial appendage closure in the US. ICE, intracardiac echocardiography; US, United States.
Figure 4
Figure 4
Adjusted and unadjusted ORs for in-hospital complications. aOR, adjusted odds ratio; ICE, intracardiac echocardiography; uOR, unadjusted odds ratio.
Figure 5
Figure 5
Cost comparison for ICE-guided LAAC. ICE, intracardiac echocardiography; LAAC, left atrial appendage closure; TEE, transesophageal echocardiography.
See this image and copyright information in PMC

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