Outcomes of Intracardiac Versus Transesophageal Echocardiography to Guide Left Atrial Appendage Occlusion: A Real-World Propensity-Matched Study
Author Department
Cardiology; Medicine
Document Type
Article, Peer-reviewed
Publication Date
3-2026
Abstract
Intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) are both used to guide left atrial appendage occlusion (LAAO). Earlier comparative analyses pre-date widespread adoption of three-dimensional ICE, and ICE was often reserved for patients with comorbidities precluding TEE. With continued technological advancements and increasing adoption of ICE, contemporary real-world comparisons are warranted. We conducted a large propensity-matched analysis using the TriNetX database to compare early outcomes between ICE- and TEE-guided LAAO from 2015 through 2025. Adults undergoing LAAO were identified using procedural codes, and 1:1 propensity score matching yielded 6,357 patients in each group. The primary outcome was major adverse events (MAE), defined as a composite of all-cause mortality, stroke, myocardial infarction, bleeding, pericardial effusion, cardiac arrest, and vascular complications. Secondary outcomes included pericardiocentesis, device-related thrombus, and peri-device leak at 7 and 45 days. At 7 days, ICE guidance was associated with a lower risk of MAE compared with TEE (766 vs. 937 events; HR 0.81, 95% CI 0.74-0.89; p< 0.0001), as well as lower rates of stroke and pericardial effusion. At 45 days, ICE remained associated with lower MAE risk (1,040 vs. 1,193 events; HR 0.87; p=0.0005), stroke, cardiac arrest, and pericardial effusion. Pericardiocentesis occurred more frequently in the ICE cohort. There were no significant differences in bleeding, device-related thrombus, peri-device leak, or mortality between groups. In conclusion, ICE-guided LAAO was associated with fewer early composite adverse events compared with TEE guidance, with similar mortality and device-related complication rates. These findings support the expanding use of ICE as an effective alternative imaging modality for LAAO.
Keywords: Intracardiac echocardiography; LAAO; Transesophageal echocardiography; Watchman.
Recommended Citation
Sawalha K, Eenna C, Abughazaleh S, Chi KY, Goldsweig AM. Outcomes of Intracardiac Versus Transesophageal Echocardiography to Guide Left Atrial Appendage Occlusion: A Real-World Propensity-Matched Study. Am J Cardiol. 2026 Mar 25:S0002-9149(26)00189-X. doi: 10.1016/j.amjcard.2026.03.039. Epub ahead of print.
PMID
41895360