Ubaid Khan MD, Ahmed Mazen Amin MBBCh, Zuhair Majeed MD, Muhammad Haris Khan MBBS, Mahmoud Shaaban Abdelgalil MBBCh, Muhammad Mubariz MD, Shrouk Ramadan MBBCh, Muhammad Imran MBBS, Ahmed Raza MBBS, Muhammad Naveed Ur Rehman MBBS, Syed Hassnain Zafar Bukhari MBBS, Ahmad Talal Asif MD, Fahad Hassan Gunjial MBBS, Junaid Ali MD, Anum Nawaz MBBS
{"title":"心内超声心动图与经食管超声心动图对房颤患者左心耳闭塞的指导：系统回顾和荟萃分析","authors":"Ubaid Khan MD, Ahmed Mazen Amin MBBCh, Zuhair Majeed MD, Muhammad Haris Khan MBBS, Mahmoud Shaaban Abdelgalil MBBCh, Muhammad Mubariz MD, Shrouk Ramadan MBBCh, Muhammad Imran MBBS, Ahmed Raza MBBS, Muhammad Naveed Ur Rehman MBBS, Syed Hassnain Zafar Bukhari MBBS, Ahmad Talal Asif MD, Fahad Hassan Gunjial MBBS, Junaid Ali MD, Anum Nawaz MBBS","doi":"10.1002/joa3.70115","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Intracardiac echocardiography (ICE) is an innovative technique that has emerged as an alternative to transesophageal echocardiography (TEE) to guide the implantation of a left atrial appendage occlusion (LAAO) device in patients with nonvalvular atrial fibrillation (AF) who cannot tolerate anticoagulants.</p>\n </section>\n \n <section>\n \n <h3> Purpose</h3>\n \n <p>We aim to review the clinical efficacy and safety of ICE compared to TEE to guide the implantation of LAAO devices in patients with AF.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and EMBASE until March 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024542537.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We included 19 studies involving 44,706 patients. ICE was associated with a statistically significant high procedure success rate compared to TEE (RR: 1.0055 with 95% CI [1.0006, 1.0104], <i>p</i> = 0.01), but there was no difference in procedure duration (MD: 3.07 with 95% CI [−4.67, 10.80], <i>p</i> = 0.44) between the two groups. However, compared to the ICE group, patients undergoing LAAO under TEE guidance required more than one device more often (RR: 1.39 with 95% CI [1.23, 1.57], <i>p</i> < 0.01). The TEE group also reported a reduced incidence of pericardial effusion compared to the ICE group (RR: 0.65 with 95% CI [0.50, 0.85], <i>p</i> < 0.01).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our meta-analysis concluded that ICE can be a viable alternative to TEE for guiding LAAO, particularly in patients unsuitable for general anesthesia. It can also reduce the need for GA and adverse effects and resources associated with it, require fewer devices, and demonstrate comparable safety and efficacy outcomes, though it may increase the risk of pericardial effusion. Further prospective trials are warranted.</p>\n </section>\n </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70115","citationCount":"0","resultStr":"{\"title\":\"Intracardiac echocardiography versus transesophageal echocardiography guidance on left atrial appendage occlusion in patients with atrial fibrillation: A systematic review and meta-analysis\",\"authors\":\"Ubaid Khan MD, Ahmed Mazen Amin MBBCh, Zuhair Majeed MD, Muhammad Haris Khan MBBS, Mahmoud Shaaban Abdelgalil MBBCh, Muhammad Mubariz MD, Shrouk Ramadan MBBCh, Muhammad Imran MBBS, Ahmed Raza MBBS, Muhammad Naveed Ur Rehman MBBS, Syed Hassnain Zafar Bukhari MBBS, Ahmad Talal Asif MD, Fahad Hassan Gunjial MBBS, Junaid Ali MD, Anum Nawaz MBBS\",\"doi\":\"10.1002/joa3.70115\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Intracardiac echocardiography (ICE) is an innovative technique that has emerged as an alternative to transesophageal echocardiography (TEE) to guide the implantation of a left atrial appendage occlusion (LAAO) device in patients with nonvalvular atrial fibrillation (AF) who cannot tolerate anticoagulants.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>We aim to review the clinical efficacy and safety of ICE compared to TEE to guide the implantation of LAAO devices in patients with AF.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and EMBASE until March 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024542537.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>We included 19 studies involving 44,706 patients. ICE was associated with a statistically significant high procedure success rate compared to TEE (RR: 1.0055 with 95% CI [1.0006, 1.0104], <i>p</i> = 0.01), but there was no difference in procedure duration (MD: 3.07 with 95% CI [−4.67, 10.80], <i>p</i> = 0.44) between the two groups. However, compared to the ICE group, patients undergoing LAAO under TEE guidance required more than one device more often (RR: 1.39 with 95% CI [1.23, 1.57], <i>p</i> < 0.01). The TEE group also reported a reduced incidence of pericardial effusion compared to the ICE group (RR: 0.65 with 95% CI [0.50, 0.85], <i>p</i> < 0.01).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Our meta-analysis concluded that ICE can be a viable alternative to TEE for guiding LAAO, particularly in patients unsuitable for general anesthesia. It can also reduce the need for GA and adverse effects and resources associated with it, require fewer devices, and demonstrate comparable safety and efficacy outcomes, though it may increase the risk of pericardial effusion. Further prospective trials are warranted.</p>\\n </section>\\n </div>\",\"PeriodicalId\":15174,\"journal\":{\"name\":\"Journal of Arrhythmia\",\"volume\":\"41 4\",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70115\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Arrhythmia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/joa3.70115\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Arrhythmia","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/joa3.70115","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
心内超声心动图（ICE）是一项创新技术，已成为经食管超声心动图（TEE）的替代方案，用于指导不能耐受抗凝剂的非瓣膜性心房颤动（AF）患者植入左心耳闭塞（LAAO）装置。目的：回顾ICE与TEE的临床疗效和安全性，以指导AF患者植入LAAO装置。方法：我们在PubMed， CENTRAL, Web of Science， Scopus和EMBASE进行了全面的检索，直到2024年3月。用风险比（RR）报告二分类结果，用平均差（MD）报告连续结果，并使用95%置信区间（CI）报告汇总数据。该系统评价和荟萃分析已注册为PROSPERO ID: CRD42024542537。结果我们纳入19项研究，涉及44,706例患者。与TEE相比，ICE的手术成功率有统计学意义（RR: 1.0055, 95% CI [1.0006, 1.0104], p = 0.01），但两组手术时间无差异（MD: 3.07, 95% CI [- 4.67, 10.80], p = 0.44）。然而，与ICE组相比，TEE指导下的LAAO患者需要一种以上器械的频率更高（RR: 1.39, 95% CI [1.23, 1.57], p < 0.01）。与ICE组相比，TEE组心包积液的发生率也有所降低（RR: 0.65, 95% CI [0.50, 0.85], p < 0.01）。我们的荟萃分析得出结论，ICE可以作为TEE指导LAAO的可行替代方案，特别是在不适合全身麻醉的患者中。尽管它可能增加心包积液的风险，但它也可以减少对GA的需求以及与之相关的不良反应和资源，需要更少的器械，并显示出相当的安全性和有效性结果。进一步的前瞻性试验是必要的。
Intracardiac echocardiography versus transesophageal echocardiography guidance on left atrial appendage occlusion in patients with atrial fibrillation: A systematic review and meta-analysis
Background
Intracardiac echocardiography (ICE) is an innovative technique that has emerged as an alternative to transesophageal echocardiography (TEE) to guide the implantation of a left atrial appendage occlusion (LAAO) device in patients with nonvalvular atrial fibrillation (AF) who cannot tolerate anticoagulants.
Purpose
We aim to review the clinical efficacy and safety of ICE compared to TEE to guide the implantation of LAAO devices in patients with AF.
Methods
We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and EMBASE until March 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024542537.
Results
We included 19 studies involving 44,706 patients. ICE was associated with a statistically significant high procedure success rate compared to TEE (RR: 1.0055 with 95% CI [1.0006, 1.0104], p = 0.01), but there was no difference in procedure duration (MD: 3.07 with 95% CI [−4.67, 10.80], p = 0.44) between the two groups. However, compared to the ICE group, patients undergoing LAAO under TEE guidance required more than one device more often (RR: 1.39 with 95% CI [1.23, 1.57], p < 0.01). The TEE group also reported a reduced incidence of pericardial effusion compared to the ICE group (RR: 0.65 with 95% CI [0.50, 0.85], p < 0.01).
Conclusion
Our meta-analysis concluded that ICE can be a viable alternative to TEE for guiding LAAO, particularly in patients unsuitable for general anesthesia. It can also reduce the need for GA and adverse effects and resources associated with it, require fewer devices, and demonstrate comparable safety and efficacy outcomes, though it may increase the risk of pericardial effusion. Further prospective trials are warranted.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
