HRS 2026 – Dr Enrico Ferro (Beth Israel Deaconess Medical Center, Boston, MA) joins us to discuss findings from the SURPASS study, a large real-world analysis nested within the NCDR LAAO Registry, comparing intracardiac echocardiography (ICE)- and transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) using the Watchman FLX device.

As ICE continues to gain traction as an alternative imaging modality for percutaneous LAAO, questions remain around its comparative safety profile. Drawing on data from nearly 100,000 patients implanted between August 2020 and September 2022, this propensity-weighted analysis offers the most comprehensive contemporary assessment of ICE versus TEE guidance to date — examining procedural outcomes at both 45 days and 24 months.

Interview Questions:
1. Why is the choice of imaging guidance for LAAO such an important clinical and practical question right now?
2. What were the aims of the SURPASS study, and what made the NCDR LAAO Registry the right platform for this analysis?
3. What were the headline procedural and safety findings — particularly around pericardial effusion, DRT, and peri-device leak at 45 days?
4. ICE was associated with lower general anaesthesia use and more same-day discharge, but also higher rates of pericardial effusion and air embolism. How should operators weigh those trade-offs?
5. What are your key take-home messages for teams considering ICE-guided LAAO, and what does the field need to address next?

Recorded on-site at HRS 2026, Chicago.
Editors: Jordan Rance
Videographer: Oliver Miles
Support: This is an independent interview produced by Radcliffe Cardiology.