title: Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman.
abstract: BACKGROUND
  Left atrial appendage occlusion (LAAO) is mostly performed by transesophageal echocardiography (TEE) guidance. Intracardiac echocardiography (ICE) may be an alternative imaging modality for LAAO that precludes the need for general anesthesia or sedation.
  
  
  RESULTS
  All consecutive single center, single operator LAAO candidates were analyzed. Baseline clinical and procedural characteristics and in-hospital outcomes were compared between patients in whom a Watchman was implanted with ICE vs. TEE guidance. In 76 consecutive patients the Watchman device was deployed under ICE in 32 patients (42%) and under TEE guidance in 44 patients (58%). Baseline characteristics were comparable between groups, except that patients in the TEE group were older (81 [75-85] years vs. 75 [68-80] years, P = 0.007). Total injected contrast media as well as fluoroscopy time were comparable between groups (90 ml [54-140] vs. 85 ml [80-110], P = 0.86 and 7.9 min [6.4-15.5] vs. 9.8 min [7.0-13.2], P = 0.51, for TEE vs. ICE, respectively). However, time from femoral venous puncture to transseptal puncture and to closure was longer in the ICE group (14 min [7.3-20] vs. 6 min [3.3-11], P = 0.007 and 48 min [40-60] vs. 34.5 min [27-44], P = 0.003, respectively). In the TEE group one patient suffered esophageal erosion with bleeding, which was managed conservatively and one non-LAAO related in-hospital mortality occurred in an 88-year-old patient. Device implantation success rate was 100% in both groups. No device embolization, no significant peri-device leak, no tamponade, no stroke, and no access site bleeding occurred in any patient. Total hospital stay for stand-alone LAAO was comparable between groups (2 days [2-2] vs. 2 days [2-3.3], P = 0.17, in ICE vs. TEE, respectively).
  
  
  CONCLUSIONS
  ICE guidance for LAAO with the Watchman device is feasible and comparable to TEE and may become the preferred imaging modality for LAAO. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Antonio H
authors.initials: AH
authors.lastname: Frangieh
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Alibegovic
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Slayman
authors.initials: S
authors.lastname: Obeid
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Manka
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Erik W
authors.initials: EW
authors.lastname: Holy
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Willibald
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D055989:Septal Occluder Device; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Watchman; atrial fibrillation; intracardiac echocardiography; left atrial appendage occlusion; oral anticoagulation; transesophageal echocardiography