SPC365

Unfreezing the Path with ICE-ing: Revolutionizing Left Atrial Appendage Occlusion

Session: SESSÃO DE COMUNICAÇÕES ORAIS 09 - CARDIOLOGIA DE INTERVENÇÃO/ESTRUTURAL
Speaker: Catarina Gregório

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.1 Invasive Imaging and Functional Assessment
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Gregório; Miguel Nobre Menezes; Ana Abrantes; Miguel Raposo; Ana Rita Francisco; Catarina Oliveira; Tiago Rodrigues; João Silva Marques; Gustavo Lima da Silva; João de Sousa; Pedro Cardoso; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Intraprocedural imaging is essential for transcatheter left atrial appendage occlusion (LAAO). While pivotal trials have relied on transesophageal echocardiography (TEE), intracardiac echocardiography (ICE) is emerging as a promising alternative, offering real-time imaging with no need for general anesthesia and potentially shorter procedural times.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To compare the procedural and clinical outcomes of LAAO guided by ICE vs&nbsp;TEE.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Single-center retrospective study of pts who underwent percutaneous LAAO between November 2009-December 2024. Patients were divided into 2 groups based on the imaging modality used: ICE or TEE. Clinical endpoints included acute and long-term safety (bleeding or device-related issues) and efficacy (absence of stroke, systemic embolism or cardiovascular death). Kaplan-Meier survival analysis was performed to evaluate the efficacy and safety endpoints.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: LAAO was attempted in 215 pts, including 61 cases (28%) with ICE and 154 (72%) with TEE. Baseline characteristics were similar between groups, although ICE pts had a lower CHA2DS2-VASc score (ICE 3.7&plusmn;0.2 vs. TEE 4.3&plusmn;0.1,p=0.01) and fewer prior ischemic strokes (ICE 24% vs. TEE 42%, p=0.02). Procedures guided by ICE had significantly shorter procedural times (ICE 61&plusmn;21 vs. TEE 92&plusmn;36 min,p=0.013), with an average reduction of 11 min. The type of device implanted (Watchman: ICE 100%, TEE 92%), mean device size (ICE 29&plusmn;1mm, TEE 28&plusmn;1mm,p=NS), and implantation success rates (ICE 95% vs. TEE 97%) were comparable, with no device embolizations in either group. None of the ICE-guided procedures required general anesthesia nor sedation.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Acute postprocedural complications were less frequent with ICE (1 minor venous access hematoma without transfusion) compared to TEE (4 pericardial effusions requiring percutaneous intervention and 3 vascular access complications, one of which major). However, all major complications occurred up to early 2015, during the initial phase of the LAAO program. After LAAO, DAPT was the preferred strategy in the TEE group, followed by VKA and aspirin, while in the ICE group, DAPT was the predominant choice (p&lt;0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Follow-up analysis is limited by shorter follow-up (24.3&plusmn;3.5months) and slightly lower CHA2DS2-VASc score in the ICE group. However, the annual stroke/systemic embolic rate was 1,6%, a 65% to 77% relative risk reduction vs the expected rate from a CHA2DS2-VASc score of 3 or 4, respectively. Furthermore, the primary safety endpoint occurred at similar rates in both groups. In the ICE group, 2 major bleeding events occurred (gastrointestinal and genitourinary) and 1 minor bleeding event, comparable to the TEE group (LogRank p=0.51).&nbsp;</span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: ICE-guided LAAO is a safe and effective alternative to traditional methods, providing comparable outcomes with reduced procedural time without affecting device implantation success rates or efficacy.</span></span></span></p>