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(Circulation. 2003;107:795.)
© 2003 American Heart Association, Inc.

Brief Rapid Communications

Intracardiac Echocardiography Is Superior to Conventional Monitoring for Guiding Device Closure of Interatrial Communications

Thomas Bartel, MD; Thomas Konorza, MD; Jawed Arjumand, MD; Tiko Ebradlidze, BS; Holger Eggebrecht, MD; Guido Caspari, MD; Ulrich Neudorf, MD; Raimund Erbel, MD

From the Divisions of Cardiology, Departments of Internal Medicine and Pediatrics, University of Essen, Essen, Germany.

Correspondence to Dr Thomas Bartel, Cardiology Division, Department of Internal Medicine, University of Essen, Hufelandstr. 55, 45122 Essen, Germany. E-mail thomas.bartel{at}uni-essen.de

Background— This study sought to test whether intracardiac echocardiography (ICE) is superior to conventional monitoring in guiding device closure of interatrial communications (atrial septal defect [ASD] and patent foramen ovale [PFO]).

Methods and Results— Forty-four patients undergoing device closure of ASD (n=6) or PFO (n=38) were randomized to have the procedure guided by either ICE (group 1; n=22) or by transesophageal echocardiography (TEE) (group 2; n=22). All interventions were completed successfully. In 1 patient from group 2, atrial fibrillation occurred 1 day after device implantation; the patient was successfully cardioverted on the next day. There were no other complications. Fluoroscopy time (FT) (6.0±1.7 minutes versus 9.5±1.6 minutes; P<0.0001) as well as procedure time (PT) (33.4±4.7 minutes versus 37.8±5.6 minutes; P<0.01) were shorter in group 1 than in group 2. Group 2 patients required general anesthesia without (n=19) or with endotracheal intubation (n=3). In contrast, ICE allowed continuous monitoring of the whole procedure, including balloon sizing before device closure, without sedation.

Conclusions— ICE is a safe tool to guide device closure of PFO and ASD. Supine patients tolerate ICE better than TEE. ICE reduces FT and PT. ICE seems to be advantageous, especially when long continuous or repeated echocardiographic viewing is required.

Key Words: heart septal defects • catheterization • echocardiography • imaging

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