Moderate conscious sedation for transesophageal echocardiography guidance of percutaneous left atrial appendage closure: The MID-DEX protocol

Objectives: The aim of this study was to assess the feasibility, effectiveness, and safety of a novel moderate conscious sedation protocol of Dexmedetomidine plus Midazolam (MID-DEX MCS) in patients undergoing transcatheter left atrial appendage closure (LAAC). Design: This is a retrospective and single-arm study. Setting: Single-center, hospital. Participants: All consecutive patients referred for LAAC. Interventions: LAAC procedures were TEE-guided under MCS using Midazolam and Dexmedetomidine. Measurements and main results: 100 patients underwent LAAC under MID-DEX MCS protocol with an acute procedural success rate of 100 %. Ninety-four patients (94 %) successfully underwent TEE guidance under MCS for LAAC. In 6 patients (6 %), ICE guidance was required. Of these, only 2 cases (2 %) were due to insufficient sedation and psychomotor agitation, while the other 4 patients (4 %) had absolute contraindications to TEE. No MCS-related complications were observed. Conversion from MCS to general anesthesia was not required in any patient. Conclusions: LAAC was safe and effective when performed under MCS. The application of the proposed MCS protocol may simplify the LAAC procedure, as well as reduce procedural time and procedural costs, while increasing overall patient and physician satisfaction.