Laterra Giulia, Dattilo Giuseppe, Correale Michele, Brunetti Natale Daniele, Artale Claudia, Sacchetta Giorgio, Pistelli Lorenzo, Borgi Marco, Campanella Francesca, Cocuzza Federica, Lo Nigro Maria Claudia, Contarini Marco
Cardiology Unit, Department of Emergency, Umberto Primo Hospital, 94100 Enna, Italy.
Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy.
J Clin Med. 2023 May 30;12(11):3756. doi: 10.3390/jcm12113756.
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. The left atrial appendage (LAA) is the most likely source of thrombus formation in patients with non-valvular atrial fibrillation (NVAF). Left atrial appendage closure (LAAC) represents an effective alternative to NOAC in patients with NVAF. Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) in addition to standard fluoroscopy to guide LAAC. TEE-guided LAAC usually requires general anesthesia. The ICE technique is a "minimalist approach", without general anesthesia, but ICE imaging techniques are not yet simplified and standardize, and the ICE may result in inferior image quality compared with that of TEE. Another "minimalist approach" can be the use of ICE via the esophageal route (ICE-TEE), that jet is validated to identify the presence of LAA thrombi in patients and to perform other procedures. In our cath laboratory ICE-TEE to guide LAAC is used in some complex patients. Indeed, our single center experience suggests that ICE-TEE could be a good alternative imaging technique to guide LAAC procedure without general anesthesia.
心房颤动（AF）是成年人中最常见的心律失常。左心耳（LAA）是非瓣膜性心房颤动（NVAF）患者血栓形成的最可能来源。左心耳封堵术（LAAC）是NVAF患者使用新型口服抗凝药（NOAC）之外的一种有效替代方法。专家共识文件建议，除了标准荧光透视法外，在LAAC术中通过经食管超声心动图（TEE）或心腔内超声心动图（ICE）进行术中成像以指导LAAC。TEE引导的LAAC通常需要全身麻醉。ICE技术是一种“极简方法”，无需全身麻醉，但ICE成像技术尚未简化和标准化，与TEE相比，ICE的图像质量可能较差。另一种“极简方法”可以是经食管途径使用ICE（ICE-TEE），经证实该方法可识别患者LAA血栓的存在并进行其他操作。在我们的导管实验室中，ICE-TEE用于指导一些复杂患者的LAAC。实际上，我们单中心的经验表明，ICE-TEE可能是一种无需全身麻醉即可指导LAAC手术的良好替代成像技术。
