Evidence map›Paper›PMID 37831030›Full record

ArticleJACC. Clinical electrophysiology2023

Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S.

Enrico G Ferro, Mohamad Alkhouli, Devi G Nair, Samir R Kapadia, Jonathan C Hsu, Douglas N Gibson, James V Freeman, Matthew J Price, Kristine Roy, Dominic J Allocco and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JACC. Clinical electrophysiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Unsuccessful percutaneous left atrial appendage occlusion: A single center perspective.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Article
  4. Article
  5. Article
  6. Review
  7. Review
  8. Review
  9. Article
  10. SCAI Position Statement on Intracardiac Echocardiography to Guide Structural Heart Disease Interventions.Journal of the Society for Cardiovascular Angiography & Interventions · 2025
    Article
  11. Article
  12. SCAI/HRS Technical Review on Transcatheter Left Atrial Appendage Occlusion.Journal of the Society for Cardiovascular Angiography & Interventions · 2025
    Article
  13. 2025 SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Atrial Appendage Occlusion.Journal of the Society for Cardiovascular Angiography & Interventions · 2025
    Article
  14. Article
  15. Article
  16. Article
  17. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Enrico G FerroRichard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Mohamad AlkhouliDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Devi G NairSt Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA.
Samir R KapadiaDepartment of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Jonathan C HsuCardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, California, USA.
Douglas N GibsonDivision of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA.
James V FreemanSection of Cardiovascular Medicine, Yale University School of Medicine, and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.
Matthew J PriceDivision of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA.
Kristine RoyBoston Scientific Corporation, Marlborough, Massachusetts, USA.
Dominic J AlloccoBoston Scientific Corporation, Marlborough, Massachusetts, USA.
Robert W YehRichard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Jonathan P PicciniDuke University Medical Center, Durham, North Carolina, USA. Electronic address: jonathan.piccini@duke.edu.

Funding

Neurocognition and Greater Maintenance of Sinus Rhythm in AF (NOGGIN AF)R01AG074185 · NIA · DUKE UNIVERSITY · PI MATHEW, JOSEPH P, PICCINI, JONATHAN PAUL · 2021 to 2025
$3.7M
NIA NIH HHS R01 AG074185
6 · The paper itself

Abstract

backgroundIntraprocedural imaging is critical for device delivery in transcatheter left atrial appendage occlusion (LAAO). Although pivotal trials of LAAO devices were conducted using transesophageal echocardiography (TEE), intracardiac echocardiography (ICE) is an emerging imaging modality.

objectivesThis study compared outcomes after ICE- and TEE-guided Watchman FLX implantation in the SURPASS (SURveillance Post Approval AnalySiS Plan) nationwide LAAO registry.

methodsBaseline characteristics were compared using chi-square and t-tests. Outcomes were reported in unadjusted and adjusted comparisons via propensity weighting.

resultsBetween August 2020 and September 2021, LAAO was attempted in 39,759 patients at 698 sites, including 2,272 cases (5.7%) with ICE and 31,835 (80.0%) with TEE. ICE and TEE patients had similar baseline characteristics and mean procedural times (ICE 82 minutes vs TEE 78 minutes). ICE patients were less likely to receive general anesthesia (54% vs 98%, P < 0.01). Successful device implantation (98.3% vs 97.6%) and complete seal rates at 45 days were similar (n = 25,280; 83% vs 82%). Most adverse event rates were similar; unadjusted mortality rates at 45 days were 1.1% for ICE vs 0.8% for TEE (P = 0.14), and 1.0% vs 0.7% (P = 0.27) in adjusted analyses. Even after adjustment, pericardial effusion rates requiring intervention were significantly higher with ICE at 45 days (1.0% vs 0.5%; P = 0.02). This rate decreased as operators performed more ICE-guided procedures, although 82% of operators had performed <10 ICE-guided procedures overall.

conclusionsIn the largest comparison to date, ICE use was infrequent. ICE and TEE both achieved high rates of complete LAAO. ICE was associated with significantly higher rates of pericardial effusion requiring intervention.

Indexed as

Atrial AppendageAtrial FibrillationPericardial EffusionCardiac CatheterizationEchocardiography, TransesophagealHumansatrial fibrillationintracardiac echocardiographyleft atrial appendage occlusionpericardial effusionperidevice leaktransesophageal echocardiography

Identifiers

PMID37831030
PMCPMC12337774

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.