Intracardiac echocardiography is superior to conventional monitoring for guiding device closure of interatrial communications.
BACKGROUND
This study sought to test whether intracardiac echocardiography (ICE) is superior to conventional monitoring in guiding device closure of interatrial communications (atrial septal defect [ASD] and patent foramen ovale [PFO]).


RESULTS
Forty-four patients undergoing device closure of ASD (n=6) or PFO (n=38) were randomized to have the procedure guided by either ICE (group 1; n=22) or by transesophageal echocardiography (TEE) (group 2; n=22). All interventions were completed successfully. In 1 patient from group 2, atrial fibrillation occurred 1 day after device implantation; the patient was successfully cardioverted on the next day. There were no other complications. Fluoroscopy time (FT) (6.0+/-1.7 minutes versus 9.5+/-1.6 minutes; P<0.0001) as well as procedure time (PT) (33.4+/-4.7 minutes versus 37.8+/-5.6 minutes; P<0.01) were shorter in group 1 than in group 2. Group 2 patients required general anesthesia without (n=19) or with endotracheal intubation (n=3). In contrast, ICE allowed continuous monitoring of the whole procedure, including balloon sizing before device closure, without sedation.


CONCLUSIONS
ICE is a safe tool to guide device closure of PFO and ASD. Supine patients tolerate ICE better than TEE. ICE reduces FT and PT. ICE seems to be advantageous, especially when long continuous or repeated echocardiographic viewing is required.
Bartel
Thomas
T
Division of Cardiology, Department of Internal Medicine, University of Essen, Essen, Germany. thomas.bartel@uni-essen.de
Konorza
Thomas
T
Arjumand
Jawed
J
Ebradlidze
Tiko
T
Eggebrecht
Holger
H
Caspari
Guido
G
Neudorf
Ulrich
U
Erbel
Raimund
R
D001281:Atrial Fibrillation / Q000209:etiology; D006328:Cardiac Catheterization / Q000295:instrumentation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock; D019160:Endosonography; D005471:Fluoroscopy; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D013997:Time Factors; D016896:Treatment Outcome