LAAC Imaging in 2025: 3D ICE vs TEE—Techniques, Safety & Workflow | SWAC Panel Sept. '25

How is left atrial appendage closure (LAAC) evolving in 2025—and what’s the role of 3D ICE vs TEE?In this SWAC session, Dr. Matthew Price and panelists share their real-world experiences and expert pearls:Why 3D ICE is becoming the standard for Watchman and Amulet proceduresKey tips to avoid air embolism and manage sedation risksHow to safely perform ICE-guided transseptal puncture and LAA imagingWhen TEE or mini-TEE probes remain the better optionCost, staffing, and program scaling strategies for high-volume centersPractical steps for single-operator workflows and nursing team integrationWhether you’re a structural heart imager, interventional cardiologist, or part of a valve clinic team, this discussion highlights the future of LAAC imaging and what it takes to safely scale programs as patient volumes grow.00:00 – Welcome & panel introduction 00:18 – Why imaging is critical for LAAC in 2025 00:37 – Matthew Price: 3D ICE is the future for Watchman and Amulet 01:03 – Boston Scientific advisory on air emboli 01:50 – Why 3D ICE outperforms 2D ICE for moderate sedation 02:11 – NCDR registry data on ICE vs TEE outcomes 02:40 – Learning curve and case volume to master ICE 03:42 – Practical workflow: efficient 3D ICE case steps 05:42 – Pre-procedure CT planning and AI sizing tools (FEOPS, DASHI) 07:11 – Tips for safe transseptal puncture with ICE guidance 09:04 – Balloon dilation vs delivery sheath crossing strategies 13:14 – Using fluoro as a backup for ICE alignment 18:08 – Aligning the ICE view to the LAA axis for accurate deployment 28:12 – Preventing air embolism during sedation-only cases 31:18 – Hydration, LA pressure checks, and sheath management 35:17 – When to choose TEE: obesity, severe OSA, or complex mitral work 40:17 – Mini-TEE probes: workflow advantages under MAC 47:01 – Pre-procedural imaging vs on-table imaging debate 52:09 – High-volume GA workflows and 4-minute deployment case 53:08 – Panel takeaways: scaling LAAC imaging programs#LAAC #Watchman #3DICE #TEE #InterventionalCardiology#StructuralHeart #CathLab #LAAO #ModerateSedation #MurmurMD