Introduction:
Stroke prevention in atrial fibrillation (AF) typically necessitates
either oral anticoagulation (OAC)1 or, when OAC is not
suitable, consideration for left atrial appendage occlusion
(LAAO)1. Historically, percutaneous LAAO is performed
under general anesthesia and is guided by trans-esophageal
echocardiography (TEE) 2,3The adoption of LAAO is
expanding, owed to heightened procedural success and diminished
complications4 . A shift toward Intracardiac echo
(ICE) guided LAAO is evident, aiming to optimize the procedure by
negating the necessity for general anesthesia and
TEE5,6 7. However, optimal LAA
imaging from right sided cardiac chambers remains
challenging8, necessitating ICE catheter placement in
the LA. This can be achieved via a second trans-septal puncture or a
singular puncture utilizing the “buddy” technique6.
In the latter, the ICE catheter’s LA traversal via the interatrial
septum (IAS) follows IAS dilation with the LAAO delivery
sheath6,9. This can be prolonged and
demands intricate ICE catheter adjustments, amplifying cardiac
perforation risks. Existing solutions encompass balloon dilation or
snare techniques post unsuccessful crossing
attempts6,10. We hypothesized that preemptive septal
balloon dilation may facilitate ICE introduction in the LA.
Our objective was to assess the impact of an 8 mm balloon pre-dilation
of the IAS on the ease of ICE catheter crossing, fluoroscopy time, and
overall procedural duration.