Left Atrial Appendage Closure
Intracardiac echo has proven to be a reasonable alternative to TEE as a guide during LAAC. In this case series, useful images were obtained using both 2D and 4D from various vantage points in the LA during LAAC with a plug device to make baseline LAA measurements, to guide deployment, and to measure device compression. Views mimicked those from the 3D TEE imaging that was also performed in the same patients. Given that the use of ICE could obviate the need for a TEE probe and general anesthesia, the threshold to place a 4D ICE catheter in the LA rather than image from the RA will be lower for LAAC procedures than for ablation procedures where a TEE probe is rarely used. In this early experience, good quality 2D and 4D images of the LAAC device and its relationship to the mitral annulus and PV limbus were easily obtained from the proximal coronary sinus suggesting that imaging from this and other sites outside of the LA may be sufficient to guide LAAC procedures with ICE. More experience is needed.