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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
See this image and copyright information in PMC

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