AUTHOR=Shang Xining , Sun Mingyu , Wang Zulu , Jin Zhiqing , Liang Ming 

TITLE=Comparison of intracardiac vs. transesophageal echocardiography for “one-stop” procedures of combined radiofrequency catheter ablation and left atrial appendage closure with the Watchman device in the treatment of atrial fibrillation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1265550

DOI=10.3389/fcvm.2023.1265550

ISSN=2297-055X

ABSTRACT=The aim of this study was to assess the efficacy and safety of "one-stop" procedures that combined radiofrequency catheter ablation (RFCA) and left atrial appendage closure (LAAC) with the Watchman device by guidance of intracardiac echocardiography (ICE) vs transesophageal echocardiography (TEE) in patients with atrial fibrillation.Patients who underwent "one-stop" procedures by guidance of ICE (n = 193,   109 males, 65.02 ± 8.47 years)  or TEE (n = 109, 69 males, 64.23 ± 7.75 years)  between January 2021 and October 2022 were prospectively enrolled in this study. Intraprocedural thrombus formation in left atrial appendage (LAA) was observed in 3 (1.46%) patients in ICE group and 15 (11.63%) patients in TEE group (P < 0.05) before LAAC. Total fluoroscopy time and dose in ICE group were less than those in TEE group. The total "one-stop" turnaround time and LAAC procedure time in ICE group were significantly shorter than those in TEE group (P < 0.05). Postoperative esophagus discomfort, nausea and vomiting, and hypotension were more often seen in TEE group (P < 0.001). There was no significant difference in matched cases between ICE and fluoroscopy measurements (P = 0.082). The TEE results related to LAAC and clinical events were similar between the two groups during follow up (P > 0.05).ICE-guided "one-stop" procedure was safe and feasible with less radiation exposure, shorter turnaround time and fewer complications and intraoperative thrombus formations compared with the TEE group. ICE offered accurate measurements in LAA dimension during LAAC. Echocardiography during the "one-stop" procedures was necessary to rule out the intraoperative thrombus.