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.