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.