Single trans-septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure
Single trans-septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure
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DOI：
10.1002/ccd.27246
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发表时间：
2018-02-01
影响因子：
2.3
通讯作者：
Maluenda, Gabriel
中科院分区：
文献类型：
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作者：
Aguirre, Daniel;Pincetti, Christian;Maluenda, Gabriel
目的：本研究旨在描述单次经间隔（TS）通道技术用于左心内超声心动图（ICE）指导左心耳（LAA）关闭手术的安全性和可行性。背景：laa闭合目前被接受为出血高风险的非瓣膜性心房颤动（NVAF）患者口服抗凝（OAC）的替代方法。目前，LAA闭合手术通常在经食管超声心动图（TEE）指导下进行。虽然ICE具有不需要深度镇静/麻醉的优点，但ICE- laa成像质量通常受到右心房的限制，需要双TS通道。方法22例非瓣膜性房颤患者在ICE引导下，使用Amplatzer Amulet装置从左心房进行LAA闭合。ICE AcuNav导管（Biosense Webster）和Amulet给药鞘通过单次TS穿刺技术进入LA。结果人群以男性为主（59.1%），平均年龄749.3岁，卒中（CHADS2平均评分3.8 +/- 1.1）和出血（HAS BLED平均评分3.5 +/- 1.3）高危人群。所有患者均成功植入Amplatzer Amulet（TM）装置。无手术相关并发症，包括器械栓塞。无重大心血管事件发生，所有患者均存活出院。在30天的随访中，所有患者仍然存活，无缺血性卒中，TEE上没有残留泄漏或装置血栓。这一初步经验表明，使用Amplatzer Amulet装置通过单次跨间隔技术从左心房引导ICE闭塞LAA是可行和安全的。
ObjectiveThis registry aimed to describe the safety and feasibility of a single trans-septal (TS) access technique for left intracardiac echocardiography (ICE) guidance of left-atrial appendage (LAA) closure procedure.BackgroundLAA closure is currently accepted as an alternative to oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (NVAF) who are at high-risk for bleeding. Currently, LAA closure procedure is typically performed under trans-esophageal echocardiogram (TEE) guidance. Although, ICE has the advantage of not requiring profound sedation/anesthesia, ICE-LAA imaging quality is often limited from the right atrium requiring double TS access.MethodsTwenty-two patients with NVAF underwent LAA closure using the Amplatzer Amulet device (St Jude Medical) under ICE guidance from the left atrium. The ICE AcuNav catheter (Biosense Webster) and the Amulet delivery sheath were advanced into the LA through single TS puncture technique.ResultsThe population was predominately male (59.1%) with a mean age of 749.3 years, at high-risk for stroke (mean CHADS2 score of 3.8 +/- 1.1) and bleeding (mean HAS BLED score of 3.5 +/- 1.3). The Amplatzer Amulet(TM) device was successfully implanted in all patients. No procedural related complications including device embolization were noted. No major cardiovascular events occurred and all patients were discharged alive. At 30-day follow-up all patients remained alive, free of ischemic stroke and with no residual leak or device thrombus on TEE.ConclusionsThis initial experience suggests that LAA occlusion with the Amplatzer Amulet device using ICE guidance from the left atrium via a single trans-septal technique is feasible and safe.