title: Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages.
abstract: BACKGROUND
  Transesophageal echocardiography (TEE) is the standard for diagnosis of atrial thrombi and is performed before ablation of atrial arrhythmias. Intracardiac echocardiography (ICE) is routinely used during these procedures and may provide an alternative imaging modality.
  
  
  OBJECTIVE
  The purpose of this study was to compare TEE and ICE for right atrial appendage (RAA) and left atrial appendage (LAA) anatomy and thrombus.
  
  
  METHODS
  This prospective blinded study enrolled 71 patients with atrial arrhythmias who presented for ablation. TEE and ICE were performed simultaneously to assess the RAA and LAA for thrombi, spontaneous echo contrast, and dimensions. ICE images were acquired sequentially from the right atrium, right ventricular outflow tract, and the pulmonary artery.
  
  
  RESULTS
  Imaging of the RAA and LAA was achieved in all 71 patients using ICE but in only in 69 patients using TEE because of inability to intubate the esophagus. A total of 4 thrombi were diagnosed (3 LAA, 1 RAA). All were detected by ICE but only 1 by TEE. Diagnostic imaging of the LAA was achieved in 71 patients (100%) with ICE and in 62 patients (87.3%) with TEE (P < .002). Spontaneous echo contrast was more commonly diagnosed with ICE (P < .01). There was strong correlation between TEE and ICE for length (r = 0.71), width (r = 0.94), and area (r = 0.88) of the LAA. Image quality with ICE was highest from the pulmonary artery and lowest from the right atrium.
  
  
  CONCLUSIONS
  ICE imaging is a viable alternative to TEE for visualization of the LAA and RAA during catheter ablation procedures.
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: eanter@bidmc.harvard.edu.
authors.forename: Elad
authors.initials: E
authors.lastname: Anter
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Joshua
authors.initials: J
authors.lastname: Silverstein
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Tschabrunn
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alexei
authors.initials: A
authors.lastname: Shvilkin
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Charles I
authors.initials: CI
authors.lastname: Haffajee
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Zimetbaum
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Buxton
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Eli
authors.initials: E
authors.lastname: Gelfand
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
mesh_terms: D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000601:surgery; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery; D001282:Atrial Flutter / Q000000981:diagnostic imaging* / Q000601:surgery; D017115:Catheter Ablation; D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Appendage; Arrhythmia; Atrial fibrillation; Echocardiography; Imaging; Pulmonary vein isolation; Thrombus