Point of care transesophageal echocardiography for thrombus surveillance after left atrial appendage occlusion: feasibility study

Background

Systemic follow-up after percutaneous left atrial appendage closure (LAAC) with transoesophageal echocardiography (TEE) or cardiac computed tomography (CT) is mandatory to exclude device-related thrombosis or peri-device leaks. However, repeated CT scans entail cumulative radiation exposure, and conventional TEE requires sedation, with potential associated risks. TEE using a smaller probe performed under topical oropharyngeal analgesia could help to reduce procedure-related discomfort while preserving diagnostic accuracy. To our knowledge, this is the first study analysing the feasibility of this point of care focused TEE.

Purpose

Our objective was to evaluate the feasibility of using mini-probe TEE to detect device-related thrombosis or peri-device leaks after percutaneous left atrial appendage closure, and patient comfort during the mini-probe TEE without sedation.

Methods

We conducted a prospective, single-centre, observational study. Consecutive patients undergoing TEE for the detection of device-related thrombosis or peri-device leaks after percutaneous left atrial appendage closure were included. Mini-probe TEE with 3D capabilities (9VT, General Electric) was proposed as the first-line approach and patients undergoing conventional TEE due to the unavailability of the mini-probe during the same period of time were included as a comparison group. For left atrial appendage closure, both disc-based and plug-based devices were used.

Results

A total of 58 patients were included (50 in the mini-probe TEE group and 8 in the conventional TEE group). Baseline characteristics were comparable between groups and are presented in table 1.

Mini-probe TEE was successfully performed in 98% of cases, with no need for venous access or intravenous medication (table 1 and 2). In the remaining case, mini-probe insertion was unsuccessful, and the procedure was converted to conventional TEE and completed uneventfully. No complications associated with the use of the mini probe were observed and overall patient satisfaction was very high. More than 90% of patients reported no or only mild discomfort, with no cases of severe anxiety or pain.

Significant reductions in total procedure time (17.5 vs 48 min, p<0.001), image acquisition time (3 vs 10 min, p<0.001), preparation and recovery time (13 vs 39.5 min, p<0.001) were observed. Image quality with the mini-probe was rated as good in 96% of cases and acceptable in the remaining cases. Device-related thrombosis was observed in 2 patients and significant peri-device leak in another 2, all in the mini-probe TEE group (p=NS).

Conclusions

Point of care TEE using a mini-probe under topical analgesia is a feasible and safe alternative to conventional TEE for follow-up after percutaneous left atrial appendage closure, enabling reliable detection of device-related thrombosis and peri-device leaks while reducing recovery time and overall procedural duration with good patient tolerance.Figure 1Figure 2