Echocardiographic Imaging Guidance for Left Atrial Appendage Closure: Intracardiac Echocardiography

Intracardiac echocardiography (ICE) has emerged as an alternative imaging modality to transesophageal echocardiography (TEE) for guiding left atrial appendage closure (LAAC) procedures. This chapter reviews the comparative benefits and limitations of ICE versus TEE guidance during LAAC. Benefits of ICE include placing imaging control in the hands of the operator, avoiding general anesthesia, and increasing procedural lab efficiency, among other benefits. However, challenges with 2D ICE also exist, such as the need for catheter manipulation to obtain multiple views, inferior resolution, and the need to cross the interatrial septum. The chapter then provides a procedural guide for ICE-guided LAAC, detailing the procedure in a step-by-step fashion. Finally, newer 3D and 4D ICE catheter technologies are discussed that simplify image acquisition and incorporate the advantages of 3D imaging from TEE to ICE. This chapter serves as a comprehensive, up-to-date guide on the utilization of ICE as compared to TEE during LAAC procedures.