Why the study?
ICE has emerged as an alternative to TEE for guiding LAAO device implantation, but its clinical efficacy and safety compared to TEE needed review.
Does intracardiac echocardiography (ICE) guidance improve procedural success and safety compared to transesophageal echocardiography (TEE) guidance in patients with atrial fibrillation undergoing left atrial appendage occlusion?
Does intracardiac echocardiography (ICE) guidance improve procedural success and safety compared to transesophageal echocardiography (TEE) guidance in patients with atrial fibrillation undergoing left atrial appendage occlusion?
ICE is a viable alternative to TEE for guiding LAAO with comparable success and reduced need for multiple devices, though it may carry a higher risk of pericardial effusion.
ICE may support use as TEE alternative in LAAO; leaves open need for RCTs to balance success versus effusion risk.
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.
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Khan et al. (2025) studied this question.
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