Snare and track (SNACK) technique: a novel approach for successful placement of an intracardiac echocardiogram catheter in the left atrium: a case report. Issue 9 (5th September 2022)

• Record Type: Journal Article
• Authors: Kawsara, Akram; Raybuck, Bryan
• Editors: Terentes-Printzios, Dimitrios; Velagapudi, Poonam; Giampatzis, Vasilios; Falconer, Debbie; Vervaat, Fabienne
• Is Part Of: European heart journal. Volume 6:Issue 9(2022)
• Publication Date: 2022-09-05
• Subjects: Case report -- Intracardiac echocardiogram -- Snare -- Left atrial appendage occlusion; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytac365
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Placing an intracardiac echocardiogram (ICE) catheter in the left atrium allows for excellent visualization of the left atrial appendage to guide left atrial (LA) appendage occlusion (LAAO). Nonetheless, it requires a separate septal puncture or a unique set of skills to navigate the ICE through a previously prepared septal puncture, which can be challenging. Case summary: This report describes a novel method to insert an ICE in the left atrium through a single septal puncture utilizing a snare technique. A 76-year-old male underwent LAAO by ICE guidance. After obtaining a standard atrial septal puncture, we were unable to advance the ICE into the left atrium. Therefore, we used a loop snare to grasp the ICE catheter-tip in the right atrium and direct it into the left atrium via the prepared septal puncture by tracking a pigtail wire that we routinely place as part of the procedure. Afterward, the left atrial appendage was successfully occluded with a Watchman device (Boston Scientific, Galway, Ireland), and the patient was discharged home without complications. Discussion: The described technique could be a helpful tool for ICE placement to the left atrium in a controlled fashion, especially when challenging anatomy is encountered.