Evidence map›Paper›PMID 42123128›Full record

ReviewJournal of clinical medicine2026

Left Atrial Appendage Occlusion in the Era of Minimalist Approaches: Anesthesia and Imaging Considerations.

Giulia Laterra, Lorenzo Scalia, Orazio Strazzieri, Federica Agnello, Claudia Reddavid, Salvatore Ingala, Daniela Russo, Chiara Barbera, Simona Guarino, Giampiero Vizzari and 3 more

Abstract readReview
In one paragraph

Review in Journal of clinical medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Giulia LaterraFaculty of Medicine and Surgery, Università Degli Studi di Enna "Kore", Piazza dell'Università, 94100 Enna, Italy.ORCID 0000-0001-8932-9045
Lorenzo ScaliaDivision of Cardiology, Ospedale Umberto I, ASP 4 di Enna, 94100 Enna, Italy.ORCID 0009-0006-8429-1619
Orazio StrazzieriDivision of Cardiology, Ospedale Umberto I, ASP 4 di Enna, 94100 Enna, Italy.ORCID 0000-0003-2971-363X
Federica AgnelloFaculty of Medicine and Surgery, Università Degli Studi di Enna "Kore", Piazza dell'Università, 94100 Enna, Italy.ORCID 0009-0004-1696-7053
Claudia ReddavidDivision of Cardiology, Ospedale Umberto I, ASP 4 di Enna, 94100 Enna, Italy.ORCID 0000-0001-7830-1426
Salvatore IngalaDivision of Cardiology, Ospedale Umberto I, ASP 4 di Enna, 94100 Enna, Italy.
Daniela RussoDivision of Cardiology, Ospedale Umberto I, ASP 4 di Enna, 94100 Enna, Italy.
Chiara BarberaDivision of Cardiology, Ospedale Umberto I, ASP 4 di Enna, 94100 Enna, Italy.ORCID 0009-0009-1834-9191
Simona GuarinoDivision of Cardiology, Ospedale Umberto I, ASP 4 di Enna, 94100 Enna, Italy.
Giampiero VizzariDepartment and Clinical and Experimental Medicine, "G. Martino" University Hospital, Via Consolare Valeria 1, 98124 Messina, Italy.ORCID 0000-0002-7672-2291
Antonio MicariDepartment and Clinical and Experimental Medicine, "G. Martino" University Hospital, Via Consolare Valeria 1, 98124 Messina, Italy.
Massimiliano MulèFaculty of Medicine and Surgery, Università Degli Studi di Enna "Kore", Piazza dell'Università, 94100 Enna, Italy.ORCID 0000-0001-6244-4473
Marco BarbantiFaculty of Medicine and Surgery, Università Degli Studi di Enna "Kore", Piazza dell'Università, 94100 Enna, Italy.ORCID 0000-0002-4903-5437

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The progressive aging of the atrial fibrillation (AF) population, frequently characterized by high ischemic and bleeding risks, has led to a substantial increase in referrals for left atrial appendage occlusion (LAAO). The expansion of indications and the high procedural success rate of LAAO have further contributed to rising procedural volumes. However, this growth introduces important challenges: LAAO candidates are often elderly and frail, with increased anesthesia-related risks, and high-volume catheterization laboratories may face logistical constraints, particularly in centers without dedicated anesthesiology support. The current gold standard approach, transesophageal echocardiography (TEE) under general anesthesia (GA), ensures optimal imaging and procedural control but may increase procedural complexity and perioperative risks. In response, minimalist strategies are increasingly explored, targeting either the anesthetic protocol or the imaging modality. Conscious sedation (CS) protocols have been adopted to reduce anesthesia-related burden while maintaining TEE guidance. Alternatively, imaging-based strategies aim to replace TEE with less invasive modalities, including intracardiac echocardiography (ICE), transesophageal-intracardiac echocardiography (TE-ICE), and MicroTEE. Each approach presents specific advantages and limitations regarding safety, feasibility, operator expertise, and institutional resources. Taken together, these findings support a patient-centered approach to LAAO, whether traditional or minimalist, in which the choice of anesthetic strategy and echocardiographic guidance is driven by institutional resources, operator expertise, and individual patient characteristics rather than by expected differences in procedural or clinical efficacy. This review summarizes current evidence on minimalist LAAO pathways and discusses their role in achieving a tailored, resource-conscious procedural model.

Indexed as

atrial fibrillationintracardiac echocardiographyintraprocedural imagingleft atrial appendage occlusionminimalist approachtransesophageal echocardiography

Identifiers

PMID42123128
PMCPMC13163381

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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.