Feasibility of intracardiac echocardiography imaging from the left superior pulmonary vein for left atrial appendage occlusion

  • Do Young Kim
  • Seung Yong Shin
  • Jin-Seok Kim
  • Seong Hwan Kim
  • Young-Hoon Kim
  • Hong Euy LimEmail author
Original Paper


Intracardiac echocardiography (ICE) is considered an alternative imaging modality for left atrium appendage occlusion (LAAO) to avoid general anesthesia. However, the quality of ICE images obtained from right atrium can be suboptimal compared with transesophageal echocardiography (TEE) imaging. Although placing an ICE probe into left atrium can improve imaging quality, there are limited data regarding procedure outcomes of ICE-guided LAAO versus TEE-guided LAAO. One hundred forty four patients who underwent LAAO with Amplatzer Cardiac Plug, Amulet, or Watchman device were enrolled from two referral institutes. TEE-guided LAAO was performed under general anesthesia or deep sedation (n = 103), and ICE-guided LAAO was conducted under local anesthesia (n = 41). An ICE probe was placed into left superior pulmonary vein (LSPV) via transseptal approach. The procedure success and complication rates of the ICE-guided LAAO were comparable with the TEE-guided LAAO (100 vs. 97.1%, p = 1.0; 2.4 vs. 6.8%, p = 0.734, respectively). The procedure time and total radiation dose were significantly lower in ICE-guided group compared with TEE-guided group (58.0 [55.0, 61.0] min vs. 80.0 [58.0, 95.0] min, p < 0.001; 456.0 [359.0, 604.0] mGy vs. 625.0 [439.0, 1502.5] mGy, p < 0.001, respectively). In multivariate analysis, younger age, the last time period of procedure, and local anesthesia were independent factors affecting shorter procedure time. ICE imaging from the LSPV provided optimal views for LAAO procedure with a significant reduction of total procedure time through performing under local anesthesia. This approach can be very useful for LAAO procedure especially in patients who are ineligible for general anesthesia.


Intracardiac echocardiography Left atrium appendage occlusion Transseptal puncture 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Do Young Kim
    • 1
  • Seung Yong Shin
    • 2
  • Jin-Seok Kim
    • 1
  • Seong Hwan Kim
    • 1
  • Young-Hoon Kim
    • 1
  • Hong Euy Lim
    • 1
    • 3
    Email author
  1. 1.Division of Cardiology, Cardiovascular Center, Korea University Guro HospitalKorea University College of MedicineSeoulRepublic of Korea
  2. 2.Division of Cardiology, Heart Research Institute, College of MedicineChung-Ang UniversitySeoulRepublic of Korea
  3. 3.Division of Cardiac Electrophysiology, Korea University Cardiovascular CenterKorea University Guro HospitalSeoulRepublic of Korea

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