[Left atrial appendage closure guided by intracardiac echocardiography in patients with left atrial appendage thrombus: a single-center experience].

Abstract

Objective: To investigate the feasibility and safety of intracardiac echocardiography (ICE)-guided left atrial appendage closure (LAAC) in patients with left atrial appendage thrombus (LAAT). Methods: This retrospective cohort study consecutively included patients with LAAT who underwent LAAC guided by ICE in the First Affiliated Hospital of Ningbo University between May 2022 and December 2024. Demographic data, history of thromboembolic events, and history of bleeding events were collected. LAAC was performed using the LAmbre device under ICE guidance. Periprocedural complications were recorded. Thromboembolic events and bleeding events were recorded during follow-up. Follow-up transesophageal echocardiography was performed to detect peridevice leak and device-related thrombus. Results: A total of 34 patients were enrolled, aged (67.2±9.6) years, including 28 males (82.4%). Among them, 14 patients had prior stroke/transient ischemic attack (TIA), and 2 experienced prior major bleeding. The LAmbre device was successfully implanted in all the patients guided by ICE. None experienced death, stroke/TIA, systemic embolism, pericardial effusion, or bleeding events. Access-site complications occurred in 3 patients. After a median follow-up of 395 (147, 653) days, none experienced death, stroke/TIA, or systemic embolism. During the follow-up period, a total of 4 bleeding events were recorded, comprising 2 major and 2 minor episodes. All patients completed transesophageal echocardiography follow-up at 6 months post-implantation, and no peridevice leak >3 mm was detected. Device-related thrombus was found in 1 patient. Conclusion: ICE-guided LAAC in patients with LAAT may be feasible and safe.