Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA.
JACC Clin Electrophysiol. 2020 Apr;6(4):393-400. doi: 10.1016/j.jacep.2019.11.014. Epub 2020 Jan 29.
The aim of this study was to compare the safety and hospital charges between intracardiac echocardiography (ICE)- and transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO).
TEE has been the gold standard imaging modality to guide LAAO. Although ICE has emerged as an alternative to guide LAAO, data on the safety, and cost effectiveness of its routine remain limited.
Consecutive patients who underwent LAAO with ICE or TEE guidance at the West Virginia University Clinic were compared for the following endpoints: 1) technical success; 2) procedure-related events; 3) hospital charges; and 4) peri-device leak, device embolization, or device thrombus at 45 days.
After excluding patients who underwent a concomitant non-LAAO intervention, 286 patients (n = 196 TEE, n = 90 ICE) were enrolled. Baseline characteristics were similar. Technical success was achieved in 97.8% and 97.4% of the patients in the ICE and TEE groups, respectively (p = 0.88). No patients in the ICE group required conversion to TEE or general anesthesia. Major procedure-related events occurred in 3.3% and 4.1% of the patients in the ICE and TEE groups, respectively (p = 0.76). Procedural and fluoroscopy times were similar (35.2 ± 11.3 min vs. 36.6 ± 15.6 min; p = 0.42 and 14.2 ± 3.6 min vs. 13.8 ± 8.9 min; p = 0.67, respectively). However, in-room time was shorter with ICE (78.7 ± 19.5 min vs. 113.6 ± 18.1 min; p < 0.001). Hospital charges were higher with ICE ($76,366 ± $8,028 vs. $71,114 ± $10,802; p < 0.001), whereas professional fees were higher with TEE ($6,033 ± $1,081 vs. $2,654 ± $395; p < 0.001). However, global charges were similar with ICE and TEE ($79,020 ± $8,241 vs. $77,147 ± $10,941; p = 0.15). Follow-up imaging at 45 ± 15 days showed similar rates of peri-device leaks, device thrombi, and iatrogenic atrial septal defects.
ICE-guided LAAO is associated with similar outcomes and hospital charges compared with TEE-guided LAAO.
本研究旨在比较心内超声心动图（ICE）与经食管超声心动图（TEE）引导下左心耳封堵（LAAO）的安全性和住院费用。
TEE 一直是指导 LAAO 的金标准成像方式。尽管 ICE 已成为引导 LAAO 的替代方法，但关于其常规应用的安全性和成本效益的数据仍然有限。
连续在西弗吉尼亚大学诊所接受 ICE 或 TEE 引导的 LAAO 的患者被比较以下终点：1）技术成功率；2）与手术相关的事件；3）住院费用；4）45 天的器械周围漏、器械栓塞或器械血栓。
排除同时接受非 LAAO 干预的患者后，共有 286 名患者（n=196 TEE，n=90 ICE）入组。基线特征相似。ICE 组和 TEE 组的技术成功率分别为 97.8%和 97.4%（p=0.88）。ICE 组无患者需要转为 TEE 或全身麻醉。ICE 组和 TEE 组分别有 3.3%和 4.1%的患者发生主要与手术相关的事件（p=0.76）。手术和透视时间相似（35.2±11.3 分钟比 36.6±15.6 分钟；p=0.42 和 14.2±3.6 分钟比 13.8±8.9 分钟；p=0.67）。然而，ICE 组的室内时间更短（78.7±19.5 分钟比 113.6±18.1 分钟；p<0.001）。ICE 组的住院费用更高（76366±8028 美元比 71114±10802 美元；p<0.001），而 TEE 组的专业费用更高（6033±1081 美元比 2654±395 美元；p<0.001）。然而，ICE 组和 TEE 组的总费用相似（79020±8241 美元比 77147±10941 美元；p=0.15）。45±15 天的随访影像学检查显示，器械周围漏、器械血栓和医源性房间隔缺损的发生率相似。
与 TEE 引导的 LAAO 相比，ICE 引导的 LAAO 具有相似的结果和住院费用。
