1. Introduction
Atrial fibrillation (AF) is the most common persistent atrial arrhythmia
worldwide. The prevalence of AF in adults is currently estimated to be
between 2% and 4%, with a 2.3-fold increase expected due to extended
life expectancy in the general population and increased search for
undiagnosed AF[1]. Cardioembolic stroke is the
most concerning complication of AF. Due to abnormal blood flow in the
left atrium, the thrombus from the left atrial appendage (LAA) is more
likely to rupture, subsequently leading to thromboembolisms in the
peripheral and cerebral arteries[2]. The primary
prevention strategy of thromboembolism for AF is the use of oral
anticoagulants (OACs). However, challenge remains due to the limitation
of adherence and bleeding risk for safety and efficacy of OACs. Since
most thrombus in nonvalvular AF originates from the LAA, left atrial
appendage occlusion was emerging as an alternative for OACs. TEE is the
standard imaging modality to guide LAAO and is the most widely used
imaging modality. However, it has some significant limitations, such as
the need for general anesthesia and a dedicated anesthetist, as well as
a significant logistical burden.
Recently, an expert consensus suggested that ICE might be severed as an
alternative imaging modality to guide LAAO[3].
However, studies comparing TEE with ICE for LAAC are limited, leading to
the related outcomes (e.g., efficacy and safety outcomes) remaining
elusive. Therefore, we evaluated the clinical outcomes of TEE and ICE
guidance for LAAO to further assess the safety and efficacy outcomes
between two imaging modalities.