Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance
Background/Purpose: Left atrial appendage closure (LAAC) is conventionally guided by fluoroscopy and transesophageal echocardiography. We introduce an LAAC technique without fluoroscopy exposure using intracardiac echocardiography (ICE) and electroanatomic mapping system (EAMS) under local anesthesi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-11-01
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| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664620303338 |
| _version_ | 1818161186697379840 |
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| author | Huimin Chu Xianfeng Du Caijie Shen Bin He Mingjun Feng Jing Liu Guohua Fu Binhao Wang |
| author_facet | Huimin Chu Xianfeng Du Caijie Shen Bin He Mingjun Feng Jing Liu Guohua Fu Binhao Wang |
| author_sort | Huimin Chu |
| collection | DOAJ |
| description | Background/Purpose: Left atrial appendage closure (LAAC) is conventionally guided by fluoroscopy and transesophageal echocardiography. We introduce an LAAC technique without fluoroscopy exposure using intracardiac echocardiography (ICE) and electroanatomic mapping system (EAMS) under local anesthesia. Methods: Seven non-valvular atrial fibrillation patients who underwent LAAC with the LAmbre devices under the ICE and EAMS guidance were compared to 7 patients following the conventional approach by propensity score matching. ICE probe was advanced into the left atrium (LA) to guide sizing and device implantation following the orthogonal tri-axial technique (Axis-X: from left pulmonary veins [PVs] to LAA; Axis-Y: from right PV ostium to LAA; Axis-Z: from lower LA to LAA). Results: The mean diameters of ostia and landing zone were 21.4 ± 3.9 mm and 20.4 ± 4.2 mm, respectively. LAmbre devices with a mean umbrella diameter of 23.7 ± 4.2 mm and cover disc diameter of 29.4 ± 3.6 mm were successfully implanted and acute complete LAA sealing without peri-device leak (PDL) were achieved in all cases. Neither fluoroscopy exposure nor contrast consumption was recorded. No procedure related complications were documented. The mean procedural time and PDLs at follow-ups were comparable to those in the conventional group. No stroke or thromboembolic events were documented. Conclusion: The fluoroscopy exposure could be minimized, even to zero, in the ICEguided LAAC procedures feasibly and safely using LAmbre devices. The orthogonal triaxial technique is considered efficacious and safe for the procedures. |
| first_indexed | 2024-12-11T16:13:46Z |
| format | Article |
| id | doaj.art-b8cd04d74bd945ac9301ca470a9d3211 |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-11T16:13:46Z |
| publishDate | 2020-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-b8cd04d74bd945ac9301ca470a9d32112022-12-22T00:59:00ZengElsevierJournal of the Formosan Medical Association0929-66462020-11-011191115861592Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidanceHuimin Chu0Xianfeng Du1Caijie Shen2Bin He3Mingjun Feng4Jing Liu5Guohua Fu6Binhao Wang7Corresponding author. Fax: +86 574 87085009.; Cardiac Arrhythmia Center, Ningbo First Hospital, Ningbo, 315010, ChinaCardiac Arrhythmia Center, Ningbo First Hospital, Ningbo, 315010, ChinaCardiac Arrhythmia Center, Ningbo First Hospital, Ningbo, 315010, ChinaCardiac Arrhythmia Center, Ningbo First Hospital, Ningbo, 315010, ChinaCardiac Arrhythmia Center, Ningbo First Hospital, Ningbo, 315010, ChinaCardiac Arrhythmia Center, Ningbo First Hospital, Ningbo, 315010, ChinaCardiac Arrhythmia Center, Ningbo First Hospital, Ningbo, 315010, ChinaCardiac Arrhythmia Center, Ningbo First Hospital, Ningbo, 315010, ChinaBackground/Purpose: Left atrial appendage closure (LAAC) is conventionally guided by fluoroscopy and transesophageal echocardiography. We introduce an LAAC technique without fluoroscopy exposure using intracardiac echocardiography (ICE) and electroanatomic mapping system (EAMS) under local anesthesia. Methods: Seven non-valvular atrial fibrillation patients who underwent LAAC with the LAmbre devices under the ICE and EAMS guidance were compared to 7 patients following the conventional approach by propensity score matching. ICE probe was advanced into the left atrium (LA) to guide sizing and device implantation following the orthogonal tri-axial technique (Axis-X: from left pulmonary veins [PVs] to LAA; Axis-Y: from right PV ostium to LAA; Axis-Z: from lower LA to LAA). Results: The mean diameters of ostia and landing zone were 21.4 ± 3.9 mm and 20.4 ± 4.2 mm, respectively. LAmbre devices with a mean umbrella diameter of 23.7 ± 4.2 mm and cover disc diameter of 29.4 ± 3.6 mm were successfully implanted and acute complete LAA sealing without peri-device leak (PDL) were achieved in all cases. Neither fluoroscopy exposure nor contrast consumption was recorded. No procedure related complications were documented. The mean procedural time and PDLs at follow-ups were comparable to those in the conventional group. No stroke or thromboembolic events were documented. Conclusion: The fluoroscopy exposure could be minimized, even to zero, in the ICEguided LAAC procedures feasibly and safely using LAmbre devices. The orthogonal triaxial technique is considered efficacious and safe for the procedures.http://www.sciencedirect.com/science/article/pii/S0929664620303338Atrial fibrillationLeft atrial appendage closureIntracardiac echocardiographyElectroanatomic mappingRadiation exposure |
| spellingShingle | Huimin Chu Xianfeng Du Caijie Shen Bin He Mingjun Feng Jing Liu Guohua Fu Binhao Wang Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance Journal of the Formosan Medical Association Atrial fibrillation Left atrial appendage closure Intracardiac echocardiography Electroanatomic mapping Radiation exposure |
| title | Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance |
| title_full | Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance |
| title_fullStr | Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance |
| title_full_unstemmed | Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance |
| title_short | Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance |
| title_sort | left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance |
| topic | Atrial fibrillation Left atrial appendage closure Intracardiac echocardiography Electroanatomic mapping Radiation exposure |
| url | http://www.sciencedirect.com/science/article/pii/S0929664620303338 |
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