Arrhythmias & electrophysiology
Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S.
Authors' conclusion
In the largest comparison to date, ICE use was infrequent. ICE and TEE both achieved high rates of complete LAAO. ICE was associated with significantly higher rates of pericardial effusion requiring intervention.
Study context
- Population
- Patients undergoing left atrial appendage occlusion (LAAO) with Watchman FLX in the SURPASS US nationwide registry, August 2020–September 2021, 698 sites
- Participants
- 39,759 patients · 698 sites
- Exposure
- Intracardiac echocardiography (ICE)- vs transesophageal echocardiography (TEE)-guided Watchman FLX implantation
- ICEn = 2,272
- TEEn = 31,835reference
- Outcome
- Successful device implantation and complete seal at 45 days
Methodological detailsnationwide registry, propensity-weighted adjusted comparisons
- Nationwide registry
- Propensity-weighted adjusted comparisons
Main finding
As reported in the abstract
Successful device implantation
Complete seal at 45 days
Observational data: associations, not effects.
Further findings
Mean procedural time
General anesthesia
P < 0.01
Mortality · 45 days · unadjusted · most adverse event rates similar
P = 0.14
Adjusted
P = 0.27
Safety
Pericardial effusion requiring intervention · 45 days · after adjustment
P = 0.02
Pericardial effusion requiring intervention · 45 days
- Rate decreased as operators performed more ICE-guided procedures; 82% of operators had performed <10 ICE-guided procedures
Original publication
Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S. JACC Clin Electrophysiol. Published 11 October 2023. doi:10.
Summarised from the published abstract; every number is checked against it