Author + information
- Received July 29, 2019
- Revision received October 15, 2019
- Accepted November 14, 2019
- Published online January 29, 2020.
- Mohamad Alkhouli, MDa,b,∗ (, )
- Zakeih Chaker, MDa,
- Fahad Alqahtani, MDa,
- Saleem Raslan, MDa and
- Bryan Raybuck, MDa
- aDivision of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
- bDepartment of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Mohamad Alkhouli, Department of Cardiovascular, Mayo Clinic School of Medicine, 200 1st Street Southwest, Rochester, Minnesota 55905.
Objectives The aim of this study was to compare the safety and hospital charges between intracardiac echocardiography (ICE)- and transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO).
Background TEE has been the gold standard imaging modality to guide LAAO. Although ICE has emerged as an alternative to guide LAAO, data on the safety, and cost effectiveness of its routine remain limited.
Methods Consecutive patients who underwent LAAO with ICE or TEE guidance at the West Virginia University Clinic were compared for the following endpoints: 1) technical success; 2) procedure-related events; 3) hospital charges; and 4) peri-device leak, device embolization, or device thrombus at 45 days.
Results After excluding patients who underwent a concomitant non-LAAO intervention, 286 patients (n = 196 TEE, n = 90 ICE) were enrolled. Baseline characteristics were similar. Technical success was achieved in 97.8% and 97.4% of the patients in the ICE and TEE groups, respectively (p = 0.88). No patients in the ICE group required conversion to TEE or general anesthesia. Major procedure-related events occurred in 3.3% and 4.1% of the patients in the ICE and TEE groups, respectively (p = 0.76). Procedural and fluoroscopy times were similar (35.2 ± 11.3 minutes vs. 36.6 ± 15.6 minutes; p = 0.42 and 14.2 ± 3.6 minutes vs. 13.8 ± 8.9 minutes; p = 0.67, respectively). However, in-room time was shorter with ICE (78.7 ± 19.5 minutes vs. 113.6 ± 18.1 minutes; p < 0.001). Hospital charges were higher with ICE ($76,366 ± $8,028 vs. $71,114 ± $10,802; p < 0.001), whereas professional fees were higher with TEE ($6,033 ± $1,081 vs. $2,654 ± $395; p < 0.001). However, global charges were similar with ICE and TEE ($79,020 ± $8,241 vs. $77,147 ± $10,941; p = 0.15). Follow-up imaging at 45 ± 15 days showed similar rates of peri-device leaks, device thrombi, and iatrogenic atrial septal defects.
Conclusions ICE-guided LAAO is associated with similar outcomes and hospital charges compared with TEE-guided LAAO.
- intracardiac echo
- left atrial appendage occlusion
- transesophageal echocardiography
- nonvalvular atrial fibrillation
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 29, 2019.
- Revision received October 15, 2019.
- Accepted November 14, 2019.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.