title: Transcatheter Left Atrial Appendage Closure Using Intracardiac Echocardiographic Guidance From the Left Atrium.
abstract: BACKGROUND
  Most commonly, left atrial appendage (LAA) occlusion procedures are performed using transesophageal echocardiography (TEE) guidance and general anaesthesia. Intracardiac echocardiography (ICE) offers potential advantages over TEE, however, ICE-guided LAA occlusion experience is limited and has been typically performed from a right-sided location where LAA visualization might be suboptimal. We sought to evaluate the efficacy and safety of percutaneous LAA occlusion using ICE guidance performed from the left atrium.
  
  
  METHODS
  Thirty-seven patients with atrial fibrillation, significant risk for stroke, and long-term contraindication to anticoagulation underwent LAA closure with the Amplatzer Cardiac Plug (St Jude Medical, Inc, St Paul, MN) with mild sedation and ICE guidance. The ICE catheter was introduced in the left atrium through a second transseptal puncture. Patients underwent preprocedural TEE to rule out thrombus and 3-month follow-up TEE to assess occlusion grade. Patient characteristics, procedural data, effectiveness of ICE imaging, quality of occlusion, and complications were prospectively recorded.
  
  
  RESULTS
  Procedural success was achieved in 36 of 37 patients (97%). Closure was complete or near complete (grade ≥3 according to ICE and angiography) in all cases where the device was released. In all cases, ICE imaging yielded good LAA and surrounding structure visualization and adequate procedural guidance. Three major procedural or in-hospital complications occurred. Median length of stay was 1 day. Follow-up TEE documented the absence of any residual peri-device leak in all but 1 (29 of 30) case.
  
  
  CONCLUSIONS
  Initial experience suggests LAA occlusion with the Amplatzer Cardiac Plug using ICE guidance from the left atrium is feasible, reproducible, and safe.
authors.affiliation: Division of Cardiology, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada. Electronic address: jbernard.masson@gmail.com.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Masson
authors.affiliation: Division of Cardiology, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.
authors.forename: Rémi
authors.initials: R
authors.lastname: Kouz
authors.affiliation: Division of Cardiology, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.
authors.forename: Mounir
authors.initials: M
authors.lastname: Riahi
authors.affiliation: Division of Cardiology, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.
authors.forename: Hien Kiem
authors.initials: HK
authors.lastname: Nguyen Thanh
authors.affiliation: Division of Cardiology, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jeannot
authors.initials: J
authors.lastname: Potvin
authors.affiliation: Division of Cardiology, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.
authors.forename: Charbel
authors.initials: C
authors.lastname: Naim
authors.affiliation: Division of Cardiology, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.
authors.forename: Reda
authors.initials: R
authors.lastname: Salem
authors.affiliation: Division of Cardiology, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Raymond
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000601:surgery*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D016292:Procedural Sedation; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D055989:Septal Occluder Device; D018084:Ultrasonography, Interventional / Q000379:methods*