OBJECTIVES: The aim of this study was to compare the efficacy and safety of intracardiac echocardiography (ICE) from the left atrium (LA) with transesophageal echocardiography (TEE) for procedural guidance of transcatheter left atrial appendage occlusion (LAAO).

BACKGROUND: TEE with general anesthesia is the current gold standard to guide LAAO. By the use of ICE from the LA, LAAO can be performed in local anesthesia and may potentially have advantages over TEE.

METHODS: A single-center, cohort study of patients undergoing LAAO with the Amplatzer Cardiac Plug or Amulet (St. Jude Medical, St. Paul, Minnesota). Procedures were guided by ICE from the LA with local anesthesia (n = 109) or TEE using general anesthesia (n = 107). All patients had pre-procedural cardiac computed tomography. Efficacy outcomes were technical success, procedural success, and peridevice leakage at TEE 8 weeks after LAAO. Safety outcome was a composite of periprocedural complications.

RESULTS: Technical success was achieved in 99% of both the TEE and ICE group. Procedural success was similar between groups: 94.4% success rate in the TEE-guided group, and 94.5% in the ICE-guided group. Major periprocedural complications occurred in 4.7% of the TEE group and 1.8% of the ICE group. Rate and degree of peridevice leak did not differ between groups at follow-up. Turnover time in the catheter laboratory, and contrast use were reduced with ICE.

CONCLUSIONS: LA ICE to guide LAAO as compared with TEE appears to be effective and safe, without increased procedure-related complications. The rate of peridevice leak is low and similar to TEE-guided procedures. Time spent in the catheterization room may decrease substantially.