loading page

Inter-atrial Septal Balloon Dilation to Facilitate Intracardiac Echocardiography Guided Left Atrial Appendage Occlusion
  • +3
  • Sandeep Goyal,
  • Ashish A. Bhimani,
  • Danesh Kella,
  • Anahita Tyagi,
  • Venkateshwar Polsani,
  • Thomas Deering
Sandeep Goyal
Piedmont Heart Institute

Corresponding Author:[email protected]

Author Profile
Ashish A. Bhimani
Piedmont Heart Institute
Author Profile
Danesh Kella
Mayo Clinic in Florida
Author Profile
Anahita Tyagi
Piedmont Heart Institute
Author Profile
Venkateshwar Polsani
Piedmont Heart Institute
Author Profile
Thomas Deering
Piedmont Heart Institute
Author Profile


Background: Percutaneous left atrial appendage occlusion (LAAO) is traditionally performed under general anesthesia with trans-esophageal echocardiography guidance. Intracardiac echo (ICE) guided LAAO closure is increasing in clinical use. The ICE catheter is crossed into LA via interatrial septum (IAS) after the septum is dilated with LAAO delivery sheath. This step can be time-consuming and requires significant ICE catheter manipulation increasing the risk of cardiac perforation. Pre-emptive septal balloon dilation can potentially help with the advancement of ICE in LA. Objective: Evaluate the effect of pre-dilation of IAS with an 8 mm balloon on ease of crossing the ICE catheter, fluoroscopy time for crossing, and overall procedure time. Methods: The Piedmont LAAO registry was used to identify consecutive patients undergoing LAAO. The initial 25 patients where balloon dilation of IAS was performed served as the experimental cohort, and the 25 consecutive patients prior to that in whom balloon dilation was not performed, served as controls. For the experimental group, after a trans-septal puncture, the sheath was retracted to the right atrium with guide wire still in the LA. An 8x40 mm Evercoss™ over the wire balloon was inflated across the IAS. The ICE catheter was then crossed into the LA using the fluoroscopic landmark of the guide wire and the ICE imaging. The sheath was then advanced along the ICE catheter via the transseptal puncture (TSP) and the procedure continued. Follow up CT imaging was obtained in 4-8 weeks. Results: Each group included 25 patients. There were no significant differences in baseline characteristics. All procedures were performed successfully with the use of conscious sedation and ICE guidance. There was a significant reduction in overall procedure time, fluoroscopy time, and time for trans-septal puncture to ICE in LA. There was no difference in the size of the acute residual interatrial shunt as measured via ICE or size and presence of iatrogenic ASD at follow up. Conclusion: Balloon dilation of TSP is safe and associated with increased efficiencies in ICE guided LAAO procedures.
Submitted to Journal of Cardiovascular Electrophysiology
29 Jan 2024Review(s) Completed, Editorial Evaluation Pending
29 Jan 2024Assigned to Editor
29 Jan 2024Submission Checks Completed
02 Feb 2024Reviewer(s) Assigned
09 Feb 2024Editorial Decision: Revise Minor
20 Feb 20241st Revision Received
21 Feb 2024Assigned to Editor
21 Feb 2024Submission Checks Completed
21 Feb 2024Reviewer(s) Assigned
24 Feb 2024Review(s) Completed, Editorial Evaluation Pending
27 Feb 2024Editorial Decision: Accept