Outcomes of Routine Intracardiac Echocardiography to Guide Left Atrial Appendage Occlusion

The aim of this study was to compare the safety and hospital charges between intracardiac echocardiography (ICE)- and transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO). TEE has been the gold standard imaging modality to guide LAAO. Although ICE has emerged as an alternative to guide LAAO, data on the safety, and cost effectiveness of its routine remain limited. Consecutive patients who underwent LAAO with ICE or TEE guidance at the West Virginia University Clinic were compared for the following endpoints: 1) technical success; 2) procedure-related events; 3) hospital charges; and 4) peri-device leak, device embolization, or device thrombus at 45 days. After excluding patients who underwent a concomitant non-LAAO intervention, 286 patients (n = 196 TEE, n = 90 ICE) were enrolled. Baseline characteristics were similar. Technical success was achieved in 97.8% and 97.4% of the patients in the ICE and TEE groups, respectively (p = 0.88). No patients in the ICE group required conversion to TEE or general anesthesia. Major procedure-related events occurred in 3.3% and 4.1% of the patients in the ICE and TEE groups, respectively (p = 0.76). Procedural and fluoroscopy times were similar (35.2 ± 11.3 min vs. 36.6 ± 15.6 min; p = 0.42 and 14.2 ± 3.6 min vs. 13.8 ± 8.9 min; p = 0.67, respectively). However, in-room time was shorter with ICE (78.7 ± 19.5 min vs. 113.6 ± 18.1 min; p < 0.001). Hospital charges were higher with ICE ($76,366 ± $8,028 vs. $71,114 ± $10,802; p < 0.001), whereas professional fees were higher with TEE ($6,033 ± $1,081 vs. $2,654 ± $395; p < 0.001). However, global charges were similar with ICE and TEE ($79,020 ± $8,241 vs. $77,147 ± $10,941; p = 0.15). Follow-up imaging at 45 ± 15 days showed similar rates of peri-device leaks, device thrombi, and iatrogenic atrial septal defects. ICE-guided LAAO is associated with similar outcomes and hospital charges compared with TEE-guided LAAO.