title: Periprocedural intracardiac echocardiography for left atrial appendage closure: a dual-center experience.
abstract: OBJECTIVE
  This dual-center study sought to demonstrate the utility and safety of intracardiac echocardiography (ICE) in providing adequate imaging guidance as an alternative to transesophageal echocardiography (TEE) during Amplatzer Cardiac Plug device implantation.
  
  
  BACKGROUND
  Over 90% of intracardiac thrombi in atrial fibrillation originate from the left atrial appendage (LAA). Patients with contraindications to anticoagulation are potential candidates for LAA percutaneous occlusion. TEE is typically used to guide implantation.
  
  
  METHODS
  ICE-guided percutaneous LAA closure was performed in 121 patients to evaluate the following tasks typically achieved by TEE: assessment of the LAA dimension for device sizing; guidance of transseptal puncture; verification of the delivery sheath position; confirmation of location and stability of the device before and after release and continuous monitoring to detect procedural complications. In 51 consecutive patients, we compared the measurements obtained by ICE and fluoroscopy to choose the size of the device.
  
  
  RESULTS
  The device was successfully implanted in 117 patients, yielding a technical success rate of 96.7%. Procedural success was achieved in 113 cases (93.4%). Four major adverse events (3 cardiac tamponades and 1 in-hospital transient ischemic attack) occurred. There was significant correlation in the measurements for device sizing assessed by angiography and ICE (r = 0.94, p < 0.0001).
  
  
  CONCLUSIONS
  ICE imaging was able to perform the tasks typically provided by TEE during implantation of the Amplatzer Cardiac Plug device for LAA occlusion. Therefore, we provide evidence that the use of ICE offered accurate measurements of LAA dimension in order to select the correct device sizes.
authors.affiliation: Adult Cardiology Department, Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy. Electronic address: berti@ftgm.it.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Adult Cardiology Department, Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Paradossi
authors.affiliation: Interventional Diagnostic Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Meucci
authors.affiliation: Adult Cardiology Department, Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trianni
authors.affiliation: Interventional Cardiology Department, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
authors.affiliation: Adult Cardiology Department, Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rezzaghi
authors.affiliation: Interventional Diagnostic Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Stolkova
authors.affiliation: Adult Cardiology Department, Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.affiliation: Interventional Diagnostic Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mori
authors.affiliation: Interventional Diagnostic Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011677:Punctures; D015641:Radiography, Interventional / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: atrial fibrillation; intracardiac echocardiography; intraprocedural imaging; left atrial appendage occlusion; transesophageal echocardiography