Intracardiac or transesophageal echocardiography for left atrial appendage occlusion: an updated systematic review and meta-analysis.

The international journal of cardiovascular imaging Pub Date : 2025-03-01 Epub Date: 2025-01-22 DOI:10.1007/s10554-025-03330-z

Eirini Beneki, Kyriakos Dimitriadis, Panagiotis Theofilis, Nikolaos Pyrpyris, Panayiotis Iliakis, Argyro Kalompatsou, Panagiotis Kostakis, Markos Koukos, Stergios Soulaidopoulos, Georgios Tzimas, Konstantinos Tsioufis, Patrizio Lancellotti, Constantina Aggeli

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Abstract

Background: Intracardiac echocardiography (ICE) appears to be a potential alternative for percutaneous left atrial appendage occlusion (LAAO) to transesophageal echocardiography (TEE). Thus, a meta-analysis was performed comparing ICE vs. TEE for LAAO guidance.

Methods: A comprehensive literature search was performed using MEDLINE, Scopus and Web of Science electronic databases from their inception to November 2023.

Results: 18 studies (124,230 patients) were included. Technical success was higher in ICE- compared to TEE-guidance (OR: 1.36, 95% CI 1.14 to 1.63, p = 0.006) and fewer devices employed (SMD: -0.22, 95% CI -0.43 to -0.01, p = 0.04, I2 = 62%). ICE guidance related with more pericardial effusion/tamponade and iatrogenic residual shunts (logRR: 0.62, 95% CI 0.36 to 0.89, p < 0.001 and RR: 1.53, 95% CI 1.12 to 2.09, p = 0.02, I2 = 1%, respectively). More vascular complications were noted in ICE group (logRR: 0.45, 95% CI 0.11 to 0.78, p = 0.009).

Conclusion: ICE-guided imaging is an effective alternative to TEE in LAAO, as it shows better efficacy than TEE, considering technical success. However, the higher rates of adverse events should be carefully considered.

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左心耳闭塞的心内或经食管超声心动图：最新的系统回顾和荟萃分析。

背景：心内超声心动图（ICE）似乎是经皮左心耳闭塞（LAAO）和经食管超声心动图（TEE）的潜在替代方案。因此，进行了一项荟萃分析，比较ICE与TEE在LAAO指导中的作用。方法：综合检索MEDLINE、Scopus和Web of Science电子数据库自成立以来至2023年11月的文献。结果：纳入18项研究（124,230例患者）。与tee指导相比，ICE的技术成功率更高（OR: 1.36, 95% CI 1.14至1.63,p = 0.006），使用的设备更少（SMD: -0.22, 95% CI -0.43至-0.01,p = 0.04, I2 = 62%）。ICE引导与更多的心包积液/压塞和医源性残余分流相关（logRR: 0.62, 95% CI 0.36 ~ 0.89, p）。结论：考虑到技术上的成功，ICE引导成像是LAAO中TEE的有效替代，其疗效优于TEE。然而，应该仔细考虑较高的不良事件发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The international journal of cardiovascular imaging

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