11 Sep 2025
Redefining and optimising LAA closure - LIVE Case
LAA closure on local anesthesia guided by ICE
Procedural Analyst:
M. A. Tebet
Summary
Supported by an unrestricted educational grant from Boston Scientific
A 78-year-old woman with atrial fibrillation and obesity (BMI 34.3), normal left ventricular function, CHADS-VASCs 5 and HAS-BLED 4, presented with severe gastrointestinal bleeding.
She underwent implantation of a Watchman FLX™ pro under local anesthesia via two right femoral venous accesses, guided by AcuNav Cristal 2D ICE.
LIVE Educational Case from University Hospitals Harrington Heart & Vascular Institute - Cleveland (Ohio), USA
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Key moments
- 06:25–09:09 - CT analysis
- 28:40–36:35 - septal puncture guided by ICE
- 39:40–41:42 - ICE septal crossing
- 23:50–25:23 - ICE imaging analysis
- 51:30–55:12 - Watchman deployment
- 55:20–59:00 - ICE imaging control
Keywords: LAA closure, Watchman FLX pro, ICE, AcuNav Cristal ICE, Septal puncture, local anesthesia
Learning Objectives
- To demonstrate a minimalist technique using intracardiac echocardiography (ICE), conscious sedation, and local anaesthesia, avoiding general anaesthesia
- To showcase procedural workflow from a high-volume US centre, emphasising safety, efficiency, and same-day discharge
- To discuss patient selection, integration of imaging, and post-procedural follow-up under a streamlined protocol
- To explore how this unique approach may expand access and applicability in diverse clinical settings