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Intracardiac echocardiographic imaging with a cartosound module for guidance of left atrial appendage closure: a comparative study with transesophageal echocardiographic imaging

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Abstract

Purpose

In most clinical trials, intracardiac echocardiography (ICE) has provided fewer views than the four standard views provided by transesophageal echocardiography (TEE) when assessing left atrial appendage closure (LAAC) devices. This study aimed to determine if ICE guided by the CartoSound system achieve adequate high-quality views and similar clinical outcomes as TEE during LAAC.

Methods

This study prospectively enrolled 202 patients who underwent LAAC using either ICE (n = 69), TEE (n = 121), or a combination of ICE and TEE (n = 12) as the procedural imaging under local anesthesia. A novel multi-angled “FLAVOR” approach was used for assessment in the ICE group.

Results

ICE allowed visualization of the implanted devices in all patients at all proposed angles with long-axis views while two-dimensional (2D) TEE showed short-axis views in 1 or 2 angles in 24.2% of cases, which was more prevalent when the pulmonary ridge was covered by the occluder. In the combined ICE-TEE cohort, 2D-TEE failed to detect peri-device leak in 1 patient. The complication rates were similar between the ICE and TEE groups. Shorter fluoroscopy time, lower radiation dose and contrast usage were founded in the ICE group. At first TEE follow-up, the rate and degree of peri-device leak were similar between the ICE and TEE groups.

Conclusion

A systematic ICE protocol using a CartoSound module to guide LAAC was reliable for comprehensive long-axis imaging assessment compared with 2D/3D TEE under local anesthesia with a shorter fluoroscopy time, lower radiation dose, and less use of contrast.

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Acknowledgements

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Funding

This work was supported by the Medical and Health Science and Technology Project of Zhejiang Province (2023KY897) and the Project of the Science and Technology of Wenzhou (Y20220080).

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Authors and Affiliations

  1. Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China

    Yanyan Chen

  2. Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China

    Yihe Chen, Liangguo Wang, Ying Fang, Weijian Huang & Fangyi Xiao

  3. Hong Kong Asia Heart Center, Canossa Hospital, Canossa, 1 Old Peak Road, Hong Kong

    Yat-Yin Lam

  4. Department of Cardiology, the Key Lab of Cardiovascular Disease of Wenzhou, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China

    Fangyi Xiao

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  1. Yanyan Chen
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  2. Yihe Chen
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  4. Liangguo Wang
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Contributions

Yanyan Chen: Wrote original draft; Yihe Chen: Visualization and investigation. Yat-Yin Lam： Writing - Reviewed and edited；Liangguo Wang and Ying Fang： TEE exam and data collection； Weijian Huang：Supervision； Fangyi Xiao：Study design, funding acquisition, resources and supervision.

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Correspondence to Fangyi Xiao.

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Chen, Y., Chen, Y., Lam, YY. et al. Intracardiac echocardiographic imaging with a cartosound module for guidance of left atrial appendage closure: a comparative study with transesophageal echocardiographic imaging. Int J Cardiovasc Imaging 39, 1667–1675 (2023). https://doi.org/10.1007/s10554-023-02880-4

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  • DOI: https://doi.org/10.1007/s10554-023-02880-4

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