Intracardiac Versus Transesophageal Echocardiography for diagnosis of left atrial appendage thrombosis in atrial fibrillation: A Meta-analysis

Introduction: Patients with atrial fibrillation excluded left atrial appendage(LAA) thrombosis is typically performed utilizing transesophageal echocardiography (TEE).Intracardiac echocardiography (ICE) can be a suitable alternative to detect thrombosis. Methods: We searched PubMed ,Cochrane Library and Embase for published abstracts and manuscripts until for published abstracts and manuscripts until June1, 2020. Studies reporting clinical outcomes comparing TEE vs. ICE for LAA thrombosis in human subjects aged ≥ 18 years were included. Two investigators independently extracted the data and individual quality assessment was performed. Analysis was performed using RevMan 5.3, STATA 15 and Meta-Disc 1.4. Results: Eight eligible studies consisting of 1108 patients (TEE = 558 vs. ICE = 550) were included. The average sensitivity of ICE and TEE to diagnose left atrial appendage thrombosis was 1.0 (95% CI: 0.91-1.00) vs 0.68 (95% CI: 0.49-0.83). The average specificity of ICE and TEE diagnosis of left atrial appendage thrombosis was 1.0 (95% CI: 0.99-1.00) vs 0.98 (95% CI: 0.96-0.99) . The AUC of ICE and TEE were 0.9846 (SEAUC = 0.0196) and 0.9655 (SEAUC = 0.0401), and the Q * statistics were 0.9462 (SEQ * = 0.0406) and 0.9127 (SEQ * = 0.0616), respectively. Z test was performed on Q * statistics (Z = 0.45, P> 0.05), there was no significant difference between ICE and TEE. Conclusion: ICE and TEE have similar diagnostic efficacy for left atrial appendage thrombosis, but ICE has higher sensitivity and specificity, which has certain advantages over TEE and has clinical application prospects