Intra cardiac echo less sensitive than trans esophageal echo in detecting left atrial appendage thrombus

Intracardiac echo is now being increasingly used to guide interventional procedures, especially in the field of electrophysiology. The Intracardiac Echocardiography Guided Cardioversion Helps Interventional Procedures (ICE-CHIP) study was a direct comparison between intracardiac echocardiography (ICE) and trans esophageal echocardiography (TEE) [Saksena S et al; ICE-CHIP Investigator Study Group. A prospective comparison of cardiac imaging using intracardiac echocardiography with transesophageal echocardiography in patients with atrial fibrillation: the intracardiac echocardiography guided cardioversion helps interventional procedures study Circ Arrhythm Electrophysiol. 2010;3:571-7]. The study prospectively evaluated the efficacy of both techniques in assessing the left atrium and interatrial septum in 95 patients. The concordance of image quality between the two techniques for imaging the left atrium was 96%. Detection of spontaneous echo contrast in the left atrium was similar by both methods. But imaging of left atrial appendage was better with trans esophageal echo (96%) than intra cardiac echo (85%). Intra cardiac thrombus was uncommon in the study (TEE, 6.9%; ICE, 5.2%). Left atrial appendage thrombus was detected more often with TEE rather than ICE.

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