Left Atrial Appendage Occlusion Guided by Intracardiac Echography: a Single Center Experience

Occlusion of the left atrial appendage (LAAO) may be indicated in patients with atrial fibrillation (AF) at risk of thromboembolic events who present contraindication for oral anticoagulation (OAC) due to an increased bleeding risk. The standard technique for percutaneous LAAO has been implantation with transesophageal echocardiography (TEE) guidance with general anesthesia. This technique requires additional hospital resources and may present drawbacks since general anesthesia could be harmful (especially in older patients) and TEE may increase procedural risks such as esophageal injuries. Intracardiac echography (ICE) is an alternative to TEE for guiding LAAO that may obviate these problems, allowing the use of local anesthesia. The aim of this study was to describe the last 10 years experience of ICE-guided LAAO procedures performed in the Interventional Cardiology Unit of the Hospital of Venice, Italy. This was a retrospective observational study that included all ICE-guided LAAO procedures performed between January 2015 and November 2024. Clinical data were collected from medical reports obtained searching through the computer databases of the Hospital. Follow-up was performed searching through the available clinical records and via telephone. Procedural details and major complications were reported. All-cause death and ischaemic cerebrovascular events were included as clinical endpoints. 50 patients (age 79.1± 6.6, 72% male) underwent LAAO between 2015 and 2024 in the interventional cardiology unit of the Hospital of Venice. Technical success was 96%; a majority of Amplatzer Amulet devices were implanted (78%). A procedural success of 88% was observed, with major complications (pericardial tamponade, device embolization requiring surgery and deep vein thrombosis) occurring in four patients. One cerebrovascular ischemic event (2.1%) occurred during a median follow-up period of 579 days. In conclusion the present study reports a single center experience of ICE-guided LAAO procedures. The efficacy of the procedure was found to be in line, if not higher, than what is reported in literature. Major complications were pericardial tamponade, device embolization and deep vein thrombosis, occurring at a rate consistent with previous reports. It is plausible that the characteristics of the study population such as age and comorbidities played a role in the mortality rates observed at one year. More case-control studies from centers that perform ICE-guided LAAO will be needed to confirm the present findings.