Abstract

DIAZ, Juan C. et al. Left atrial appendage occlusion guided by intracardiac echocardiography vs. transesophageal echocardiography: a systematic review. Rev. Colomb. Cardiol. [online]. 2023, vol.30, n.5, pp.275-285.  Epub Nov 06, 2023. ISSN 0120-5633.  https://doi.org/10.24875/rccar.22000108.

Left atrial appendage occlusion has proven to be an effective strategy in reducing the risk of stroke and systemic embolism in patients with atrial fibrillation. Worldwide, most left atrial appendage occlusions are performed using transesophageal echocardiography, which requires the use of monitored anesthesia care or general anesthesia, resulting in prolonged in-room and procedural times, delays in procedural scheduling (due to a low availability of anesthetic and echocardiography services) and the risks associated with anesthesia per se. Moreover, the additional personnel required to perform left atrial appendage occlusion guided by transesophageal echocardiography increases the number of people exposed to ionizing radiation, which is particularly high for the transesophageal echocardiography operator, who stands beside the fluoroscopy tube and frequently introduces his/her hands in the fluoroscopy field. Intracardiac echocardiography has gained acceptance to guide left atrial appendage occlusion in recent years, given its high availability in electrophysiology labs, as well as its potential to reduce in-room and procedural times, reduce the need for extensive recovery times, avoid the use of general anesthesia and facilitating same-day discharge, all of which could result in a reduction of total procedure-related costs. In this article, we discuss the evidence supporting the use of intracardiac echocardiography guidance during left atrial appendage occlusion.

Keywords : Intracardiac echocardiography; Transesophageal echocardiography; Left atrial appendage occlusion; Adverse events; Outcomes.

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