# ICE-gestuurde LAAC toont lage stroke- en bloedingsrisico’s op lange termijn

*geplaatst 2026-08-07 · Atriumfibrilleren · International journal of cardiology · doi 10.1016/j.ijcard.2026.134664 · https://hartvaat.nl/2026/10/15/ice-gestuurde-laac-toont-lage-stroke-en-bloedingsrisicos-op-lange-termijn/*

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.

## English: Long-term outcomes of ICE-guided left atrial appendage occlusion from a large single-center experience.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: International journal of cardiology, https://doi.org/10.1016/j.ijcard.2026.134664. Bijgewerkt 2026-08-10T10:36:40Z. 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.