title: Intracardiac echocardiography is superior to conventional monitoring for guiding device closure of interatrial communications.
abstract: 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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Essen, Essen, Germany. thomas.bartel@uni-essen.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Bartel
authors.forename: Thomas
authors.initials: T
authors.lastname: Konorza
authors.forename: Jawed
authors.initials: J
authors.lastname: Arjumand
authors.forename: Tiko
authors.initials: T
authors.lastname: Ebradlidze
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Guido
authors.initials: G
authors.lastname: Caspari
authors.forename: Ulrich
authors.initials: U
authors.lastname: Neudorf
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
mesh_terms: 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