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Updated: Jul 25, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Intracardiac echocardiography probe via oesophageal to guide percutaneous left atrial appendage closure procedure: a
Giulia Laterra1, Claudia Artale2, Giorgio Sacchetta2
1Cardiology Unit, Umberto I Hospital, contrada Ferrante, 94100 Enna, Italy.
Insights
Intracardiac echocardiography (ICE) via the esophagus offers a novel approach to guide left atrial appendage closure (LAAC) in complex patients. This ICE-TEE technique provides a safe and effective alternative when traditional methods are challenging.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Procedures
Background:
- Left atrial appendage closure (LAAC) is an alternative to anticoagulation for non-valvular atrial fibrillation patients at high risk of stroke and bleeding.
- Traditional guidance for LAAC includes transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE).
Observation:
- Three case reports detail the use of an esophageal intracardiac echocardiography (ICE) probe as an alternative guidance method for LAAC.
- This approach was utilized in patients with contraindications or difficulties with conventional TEE, including Brugada syndrome and oropharyngeal abnormalities.
- The ICE probe was successfully employed to guide the entire LAAC procedure, ensuring adequate visualization.
Findings:
- This case series represents the first documented use of ICE via the esophageal route (ICE-TEE) to guide the complete LAAC procedure.
- The ICE-TEE method successfully provided all necessary echocardiographic views for LAAC.
- The technique demonstrated feasibility in visualizing the left atrial appendage and guiding device deployment.
Implications:
- ICE-TEE offers a viable alternative guidance strategy for LAAC, particularly in patients with anatomical challenges or intolerance to standard TEE.
- This approach may enhance the safety and accessibility of LAAC procedures in complex patient populations.
- Further research into ICE-TEE for LAAC could expand its clinical application and optimize patient outcomes.
Background:
Left atrial appendage closure (LAAC) can be an alternative to oral anticoagulant therapy in patients with non-valvular atrial fibrillation, characterized by high risk of stroke (CHA2D2VASC ≥ two for men and CHA2D2VA2SC ≥ three for women) and high risk of bleeding (HASBLED = 3).
Case Summary:
We describe three case reports in which an intracardiac echocardiography probe was used via the oesophageal route as an alternative to traditional transoesophageal echocardiography (TEE) or ICE methods to guide LAAC. Guiding the procedure via conventional TEE, even if feasible, could be difficult in these patients due to different causes: one patient was affected by Brugada syndrome while the other two patients reported oropharyngeal abnormalities. For these reasons, we performed an alternative use of the ICE probe to guide the entire LAAC procedure.
Discussion:
Currently, LAAC is performed using intracardiac or transoesophageal echocardiography. This alternative use of ICE probe via oesophageal (ICE-TEE) is reported in previous studies that describe the feasibility of this technique both in excluding the presence of thrombus in left atrial appendage before cardioversion and in guiding percutaneous foramen ovale closure. Therefore, the ICE probe has been used as an intraoperative transoesophageal echocardiographic probe to repair congenital heart disease in infants or children with oropharyngeal abnormalities.This case series reports the first use of ICE-TEE to guide the entire LAAC procedure, guaranteeing the visualization of all echocardiographic views needed to perform it. The present case series highlights the potential of ICE-TEE to safely perform both pre-procedural and intraoperative evaluations in LAAC procedure.
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