心内超声心动图与经食管超声心动图用于左心耳封堵术：一项更新的系统评价和荟萃分析。
Intracardiac vs transesophageal echocardiography for left atrial appendage occlusion: An updated systematic review and meta-analysis.
作者信息
Serpa Frans, Rivera André, Fernandes Julia M, Braga Marcelo Antonio Pinheiro, Araújo Beatriz, Ferreira Felix Iuri, Ferro Enrico Giuseppe, Zimetbaum Peter J, d'Avila Andre, Kramer Daniel B
机构信息
Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Division of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil.
出版信息
Heart Rhythm. 2025 Mar;22(3):786-795. doi: 10.1016/j.hrthm.2024.08.027. Epub 2024 Aug 16.
BACKGROUND
Multiple studies continue to evaluate the use of intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) for guiding left atrial appendage occlusion (LAAO).
OBJECTIVE
The purpose of this study was to conduct an updated meta-analysis comparing the effectiveness and safety outcomes of both imaging modalities.
METHODS
PubMed, Cochrane, and Embase were searched for studies comparing ICE vs TEE to guide LAAO. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. The primary effectiveness endpoint was procedural success. The primary safety endpoint included the overall complications rate. Additional safety outcomes were assessed as secondary endpoints. Subgroup analysis of primary endpoints was conducted according to device type (Amulet, LAmbre, Watchman, Watchman FLX) and study region (American, Asia, Europe). R Version 4.3.1 was used for all statistical analyses.
RESULTS
Our meta-analysis included 19 observational studies encompassing 42,474 patients, of whom 4415 (10.4%) underwent ICE-guided LAAO. Compared with TEE, ICE was associated with a marginally higher procedural success (OR 1.33; 95% CI 1.01-1.76; P = .04; I = 0%). There was no significant difference in the overall complications rate (OR 1.02; 95% CI 0.77-1.36; P = .89; I = 5%). However, ICE showed higher rates of pericardial effusion (OR 2.11; 95% CI 1.47-3.03; P <.001; I = 0%) and residual iatrogenic atrial septal defect (iASD) (OR 1.52; 95% CI 1.15-2.03; P <.004; I = 0%). Subgroup analysis revealed variations in procedural success within the ICE group across study regions (P = .02).
CONCLUSION
In this updated meta-analysis, the increasing adoption of ICE-guided LAAO demonstrated higher procedural success rates compared to TEE, although with limited statistical significance. Overall complication rates were similar; however, ICE showed higher rates of pericardial effusion and residual iASD.
背景
多项研究持续评估心腔内超声心动图（ICE）和经食管超声心动图（TEE）在指导左心耳封堵术（LAAO）中的应用。
目的
本研究旨在进行一项更新的荟萃分析，比较两种成像方式的有效性和安全性结果。
方法
检索PubMed、Cochrane和Embase数据库，查找比较ICE与TEE指导LAAO的研究。采用随机效应模型汇总95%置信区间（CI）的比值比（OR）。主要有效性终点为手术成功。主要安全终点包括总体并发症发生率。其他安全结果作为次要终点进行评估。根据器械类型（Amulet、LAmbre、Watchman、Watchman FLX）和研究地区（美国、亚洲、欧洲）对主要终点进行亚组分析。所有统计分析均使用R版本4.3.1。
结果
我们的荟萃分析纳入了19项观察性研究，涵盖42474例患者，其中4415例（10.4%）接受了ICE指导的LAAO。与TEE相比，ICE的手术成功率略高（OR 1.33；95%CI 1.01-1.76；P = 0.04；I² = 0%）。总体并发症发生率无显著差异（OR 1.02；95%CI 0.77-1.36；P = 0.89；I² = 5%）。然而，ICE的心包积液发生率较高（OR 2.11；95%CI 1.47-3.03；P <0.001；I² = 0%）和残余医源性房间隔缺损（iASD）发生率较高（OR 1.52；95%CI 1.15-2.03；P <0.004；I² = 0%）。亚组分析显示，ICE组在不同研究地区的手术成功率存在差异（P = 0.02）。
结论
在这项更新的荟萃分析中，与TEE相比，ICE指导的LAAO应用增加，显示出更高的手术成功率，尽管统计学意义有限。总体并发症发生率相似；然而，ICE的心包积液和残余iASD发生率较高。
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