Arrhythmias & electrophysiology
Comparative Outcomes of Intracardiac vs Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion: Insights From EMERGE LAA Postapproval Study
Authors' conclusion
In the largest comparison to date, both ICE and TEE are safe and effective for Amulet LAAO guidance, with high acute success and closure rates. ICE was associated with longer procedure times that decreased with operator experience, potentially reflecting a learning curve.
Study context
- Population
- Patients with Amulet left atrial appendage occlusion (LAAO) implants in the NCDR LAAO Registry, August 14, 2021–December 15, 2023
- Participants
- 11,848 patients
- Exposure
- Intracardiac echocardiography (ICE) vs transesophageal echocardiography (TEE) vs ICE plus TEE guidance for Amulet LAAO
- ICEn = 433
- TEEn = 9,793reference
- ICE plus TEEn = 1,622
- Outcome
- Safety composite:
- All-cause death
- Ischemic stroke
- Systemic embolism
- Device- or procedure-related events requiring open cardiac surgery or major endovascular intervention
- Follow-up
- 7 days or hospital discharge
Methodological detailssecondary analysis of the EMERGE LAA postapproval study, National Cardiovascular Data Registry LAAO Registry
- Secondary analysis of the EMERGE LAA postapproval study
- National Cardiovascular Data Registry LAAO Registry
Main finding
As reported in the abstract
Safety composite endpoint
Odds ratio (95% CI)
ICE vs TEE
0.97(0.36–2.66)
ICE vs ICE plus TEE
1.37(0.43–4.31)
Observational data: associations, not effects.
Further findings
Implantation success
Procedural time
Median (Q1-Q3) ICE 98.0 minutes (78.0-122.0) · TEE 75.0 minutes (57.0-99.0) · ICE plus TEE 88.5 minutes (71.0-116.0)
- Implantation success: P = 0.324
- Procedural time: P < 0.001
Clinically relevant closure (≤3-mm peridevice leak) · 45 days
- Similar in all groups
- >95%
Safety
| Outcome | ICE | TEE | ICE plus TEE | OR (95% CI) | |
|---|---|---|---|---|---|
| Major adverse event composite · 45 days — ICE vs TEE | 7.1% | 6.7% | 5.7% | 1.08 (0.75–1.57) | |
| Major adverse event composite · 45 days — ICE vs ICE plus TEE | 1.27 (0.83–1.93) | ||||
| 0.512Odds ratio (log scale) |
- Major adverse event composite: overall P = 0.336
Original publication
Comparative Outcomes of Intracardiac vs Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion: Insights From EMERGE LAA Postapproval Study. JACC Cardiovasc Interv. Published 25 October 2025. doi:10.
Summarised from the published abstract; every number is checked against it