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.