{"id":"b90eb3d21c41","type":"article","url":"https://hartvaat.nl/2026/10/15/ice-gestuurde-laac-toont-lage-stroke-en-bloedingsrisicos-op-lange-termijn/","title":"ICE-gestuurde LAAC toont lage stroke- en bloedingsrisico’s op lange termijn","title_en":"Long-term outcomes of ICE-guided left atrial appendage occlusion from a large single-center experience.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"International journal of cardiology","doi":"10.1016/j.ijcard.2026.134664","source_url":"https://doi.org/10.1016/j.ijcard.2026.134664","authors":["Luigi Emilio Pastormerlo","Angela Buonpane","Giancarlo Trimarchi","Francesco Orazi","Giovanni Benedetti","Marta Casula","Augusto Esposito","Massimiliano Mariani","Andreina D'Agostino","Federica Marchi","Simone Sorbo","Alessio Lilli","Fausto Pizzino","Umberto Paradossi","Sergio Berti"],"significance":5,"published":"2026-08-07","source_date":"2026-10-15","image":"","kennis":[],"congress":"","summary_en":"A single-center retrospective cohort of 411 patients undergoing intracardiac echocardiography (ICE)-guided left atrial appendage closure (LAAC) between 2009 and 2024 demonstrated a 99.8% technical success rate and a 5.1% major adverse event rate. Over a mean follow-up of 44 months, the annualized stroke/TIA rate was 1.7% (73% lower than CHA₂DS₂-VASc predicted) and major bleeding occurred at 1.1% per year. These findings support ICE guidance as a safe and effective alternative to TEE for LAAC, offering favorable long-term ischemic and bleeding outcomes in a high-risk atrial fibrillation population.","created":"2026-08-01T01:04:58Z","updated":"2026-08-10T10:36:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectief cohort van 411 patiënten die tussen 2009 en 2024 een ICE-gestuurde sluiting van het linkeratriumappendage (LAAC) ondergingen, toonde een technische succesrate van 99,8% en een laag aantal ernstige complicaties (5,1%). Na een gemiddelde follow-up van 44 maanden lag het jaarlijkse stroke- en TIA-risico op 1,7% (73% lager dan verwacht) en het bloedingsrisico op 1,1%. Deze resultaten bevestigen dat ICE-geleiding een veilige en effectieve methode is voor LAAC, met gunstige lange-termijnuitkomsten voor patiënten met atriumfibrilleren.","abstract_original":"BACKGROUND: Intraprocedural imaging is pivotal for guidance of left atrial appendage closure (LAAC) to minimize complications and ensure optimal sealing. Intracardiac echocardiography (ICE) has emerged as a less invasive alternative to transesophageal echocardiography (TEE), although long-term outcome data remain limited. OBJECTIVES: To evaluate procedural success and long-term clinical outcomes of ICE-guided LAAC in a large single-center cohort. METHODS: Consecutive patients undergoing ICE-guided LAAC (January 2009-March 2024) were analyzed. Kaplan-Meier and Cox regression assessed time-to-event outcomes and mortality predictors; supplementary Aalen-Johansen competing-risk analyses derived cumulative incidence functions (CIF) for non-fatal endpoints, with all-cause mortality as the competing event. RESULTS: Among 411 patients, technical and procedural success were 99.8% and 94.9%, respectively. Major adverse events occurred in 5.1%, mainly pericardial tamponade (2.9%); no in-hospital deaths. Over a mean follow-up of 44.2months, all-cause mortality was 45.3% (annualized rate 10.9%). Twenty-one ischemic events occurred (annualized rate 1.7%), yielding an observed-to-expected ratio of 0.27 (95%CI: 0.17-0.41) versus the CHA₂DS₂-VASc-predicted burden (73% relative reduction). Major bleeding occurred in 3.2% (annualized rate 1.1%). Five-year CIF estimates were 5.12% for stroke/TIA and 2.65% for major bleeding (ISTH). Advancing age, renal insufficiency, diabetes mellitus, and reduced LVEF independently predicted all-cause mortality. CONCLUSIONS: ICE-guided LAAC is safe and highly effective, with favorable long-term outcomes and low ischemic and bleeding event rates in a high-risk population."}