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Meta-Analysis
. 2025 Mar;41(3):489-505.
doi: 10.1007/s10554-025-03330-z. Epub 2025 Jan 22.

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

Eirini Beneki  1   2 , Kyriakos Dimitriadis  3 , Panagiotis Theofilis  3 , Nikolaos Pyrpyris  3 , Panayiotis Iliakis  3 , Argyro Kalompatsou  3 , Panagiotis Kostakis  3 , Markos Koukos  3 , Stergios Soulaidopoulos  3 , Georgios Tzimas  4 , Konstantinos Tsioufis  3 , Patrizio Lancellotti  5 , Constantina Aggeli  3
Affiliations
Meta-Analysis

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

Eirini Beneki et al. Int J Cardiovasc Imaging. 2025 Mar.

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.

Keywords: Echocardiography; Intracardiac; Left atrial appendage; Occlusion; Transesophageal.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Conflict of interest: None.

Figures

Fig. 1
Fig. 1
Flowchart of the processing of the included studies
Fig. 2
Fig. 2
Forest plot demonstrating the differences in (A) technical success and (B) devices used between ICE and TEE in LAAC procedures. OR: odds ratio, CI: confidence interval, SMD: standardized mean difference
Fig. 3
Fig. 3
Forest plot demonstrating the differences in the incidence of (A) pericardial effusion/tamponade and (B) iatrogenic atrial septal defect (ASD) between ICE and TEE in LAAC procedures. RR: risk ratio, CI: confidence interval
Fig. 4
Fig. 4
Forest plot demonstrating the differences in the incidence of (A) vascular complications, (B) any bleeding, and (C) major bleeding events between ICE and TEE in LAAC procedures. RR: risk ratio, CI: confidence interval
Fig. 5
Fig. 5
Forest plot demonstrating the differences in the incidence of (A) peridevice leak, (B) peridevice leak > 5 mm, (C) device-related thrombus, and (D) device embolization between ICE and TEE in LAAC procedures. RR: risk ratio, CI: confidence interval
Fig. 6
Fig. 6
Forest plot demonstrating the differences in (A) procedure time and (B) fluoroscopy time between ICE and TEE in LAAC procedures. MD: mean difference, CI: confidence interval
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References

    1. Staerk L, Sherer J, Ko D et al (2017) Atrial fibrillation epidemiology, pathophysiology, and clinical outcomes. Circ Res 120(9):1501–1517 - PMC - PubMed
    1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan G-A, Dilaveris PE et al (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. ;42:373–498. 10.1093/eurheartj/ehaa612. Erratum in Eur. Heart J. 2021, 42, 507 + 546–547 + 4194 - PubMed
    1. Mahajan R, Brooks AG, Sullivan T, Lim HS, Alasady M, Abed HS, Ganesan AN, Nayyar S, Lau DH, Roberts-Thomson KC et al (2012) Importance of the underlying substrate in determining thrombus location in atrial fibrillation: implications for left atrial appendage closure. Heart 98:1120–1126. 10.1136/heartjnl-2012-301799 - PubMed
    1. Collado FMS, von Buchwald CML, Anderson CK, Madan N, Suradi HS, Huang HD, Jneid H, Kavinsky CJ (2021) Left atrial appendage occlusion for Stroke Prevention in Nonvalvular Atrial Fibrillation. J Am Heart Assoc 10:e022274. 10.1161/JAHA.121.022274 - PMC - PubMed
    1. Dudzińska-Szczerba K, Kułakowski P, Michałowska I, Baran J (2022) Association between Left Atrial Appendage Morphology and function and the risk of ischaemic stroke in patients with Atrial Fibrillation. Arrhythmia Electrophysiol Rev 11:e09. 10.15420/aer.2022.08 - PMC - PubMed

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