Intracardiac echocardiography demonstrated a comparable procedural success rate (RR 1.01) to transesophageal echocardiography for guiding percutaneous left atrial appendage occlusion.
Meta-Analysis (n=3,610)
Yes
Does intracardiac echocardiography improve procedural success and safety in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion compared to transesophageal echocardiography?
Intracardiac echocardiography demonstrates comparable procedural success, safety, and procedural times compared to traditional transesophageal echocardiography for guiding percutaneous left atrial appendage occlusion.
Effect estimate: RR 1.01 (95% CI 1.00-1.02)
p-value: p=0.171
Background Accumulated clinical studies utilized intracardiac echocardiography (ICE) to guide percutaneous left atrial appendage occlusion (LAAO). However, its procedural success and safety compared to traditional transesophageal echocardiography (TEE) remained elusive. Therefore, we performed a meta-analysis to compare efficacy and safety of ICE and TEE for LAAO. Methods We screened studies from four online databases (including the Cochrane Library, Embase, PubMed, and Web of Science) from their inception to 1 December 2022. We used a random or fixed-effect model to synthesize the clinical outcomes and conducted a subgroup analysis to identify the potential confounding factors. Results A total of twenty eligible studies with 3,610 atrial fibrillation (AF) patients (1,564 patients for ICE and 2,046 patients for TEE) were enrolled. Compared with TEE group, there was no significant difference in procedural success rate risk ratio (RR) = 1.01; P = 0.171, total procedural time weighted mean difference (WMD) = −5.58; P = 0.292, contrast volume (WMD = −2.61; P = 0.595), fluoroscopic time (WMD = −0.34; P = 0.705; I 2 = 82.80%), procedural complications (RR = 0.82; P = 0.261), and long-term adverse events (RR = 0.86; P = 0.329) in the ICE group. Subgroup analysis revealed that ICE group might be associated with the reduction of contrast use and fluoroscopic time in the hypertension proportion 90 subgroup, with lower total procedure time, contrast volume, and the fluoroscopic time in device type subgroup with multi-seal mechanism, and with the lower contrast use in paroxysmal AF (PAF) proportion ≤50 subgroup. Whereas, ICE group might increase the total procedure time in PAF proportion 50 subgroup and contrast use in multi-center subgroup, respectively. Conclusion Our study suggests that ICE may have comparable efficacy and safety compared to TEE for LAAO.
Zhang et al. (Wed,) conducted a meta-analysis in Atrial fibrillation (n=3,610). Intracardiac echocardiography (ICE) vs. Transesophageal echocardiography (TEE) was evaluated on Procedural success rate (RR 1.01, 95% CI 1.00-1.02, p=0.171). Intracardiac echocardiography demonstrated a comparable procedural success rate (RR 1.01) to transesophageal echocardiography for guiding percutaneous left atrial appendage occlusion.