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Updated: Jun 12, 2026
Three-Dimensional Modeling of the Left Atrium and Pulmonary Veins with a Precise Intracardiac Echocardiography Approach
Published on: June 30, 2023
Intracardiac echocardiography off piste? Closure of the left atrial appendage using ICE and local anesthesia
Simon T MacDonald1, James D Newton, Oliver J Ormerod
1Department of Cardiology, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom.
Insights
Left atrial appendage occlusion, a stroke risk reduction method for patients with atrial arrhythmia, was successfully performed under local anesthesia. This novel technique utilized intracardiac echocardiography for precise device deployment, potentially expanding patient eligibility.
Area of Science:
- Cardiology
- Medical Devices
- Echocardiography
Background:
- Left atrial appendage (LAA) occlusion is a key stroke prevention strategy for patients with atrial arrhythmia, particularly those unsuitable for anticoagulation.
- Standard LAA occlusion procedures typically require general anesthesia and transesophageal echocardiography for device deployment guidance.
- High-anesthetic risk patients often face limitations in undergoing such interventions.
Observation:
- A novel approach to LAA occlusion was employed in a patient with high anesthetic risk.
- This technique involved local anesthesia instead of general anesthesia.
- An intracardiac echo probe was uniquely positioned via a Mullins sheath into the right ventricular outflow tract and pulmonary artery.
Findings:
- Accurate visualization of the left atrial appendage and device deployment was achieved using the novel intracardiac echo probe placement.
- The procedure was successfully completed under local anesthesia, demonstrating feasibility in a high-risk patient.
- This method allowed for precise guidance of the occlusion device.
Implications:
- This technique may broaden the eligibility for LAA occlusion procedures to include patients with high anesthetic risk.
- Potential benefits include reduced procedure time, decreased fluoroscopy exposure, and lower procedure-related morbidity.
- This innovative imaging approach could enhance the safety and accessibility of LAA occlusion therapy.
Abstract:
Left atrial appendage (LAA) occlusion is increasingly accepted to reduce the risk of stroke in patients with atrial arrhythmia who are unsuitable for routine anticoagulation. It is generally performed under general anesthesia, guided by transoesophageal echocardiography with accurate imaging being essential for correct deployment of the device. We present a case where LAA occlusion was done under local anesthesia in a high-anesthetic risk patient, using novel placement of an intracardiac echo probe via a Mullins sheath in the right ventricular outflow tract and pulmonary artery. This allowed accurate visualization of device deployment in the LAA. This technique may increase the spectrum of patients who may benefit from the procedure and decrease procedure time, fluoroscopy, and procedure-related morbidity.
