Abstract
Background: Simultaneous atrial fibrillation (AF) catheter ablation and
left atrial appendage closure (LAAC) is sometimes recommended for both
rhythm control and stroke prevention. However, the advantages of
intracardiac echocardiography (ICE) guidance for this combined procedure
have been scarcely reported. To evaluate the clinical outcomes and
safety of ICE guided LAAC within a zero-fluoroscopy catheter ablation
procedure.
Methods and Results:From April 2019 to April 2020, 56 patients with
symptomatic AF underwent concomitant catheter ablation and LAAC. ICE
with a multi-angled imaging protocol mimicking the TEE echo windows was
used to guide LAAC. Successful radiofrequency catheter ablation and LAAC
was achieved in all patients. Procedure-related adverse event rate was
3.6%. During the 12-month follow-up, 77.8% of patients became free of
arrhythmia recurrences and oral anticoagulants were discontinued in
96.4% of patients. No ischemic stroke occurred despite two cases of
device-related thrombosis versus an expected stroke rate of 4.8% based
on the CHA2DS2-VASc score. The overall
major bleeding events rate was 1.8%, which represented a relative
reduction of 68% versus an expected bleeding rate of 5.7% based on the
HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial
septal defect secondary to a single transseptal access dropped from
57.9% at 2 months to 4.2% at 12 months TEE follow-up.
Conclusion:The combination of catheter ablation and LAAC under ICE
guidance was safe and effective in AF patients with high stroke risk.
ICE with our novel protocol was technically feasible for comprehensive
and systematic assessment of device implantation.