Beneki Eirini, Dimitriadis Kyriakos, Theofilis Panagiotis, Pyrpyris Nikolaos, Iliakis Panayiotis, Kalompatsou Argyro, Kostakis Panagiotis, Koukos Markos, Soulaidopoulos Stergios, Tzimas Georgios, Tsioufis Konstantinos, Lancellotti Patrizio, Aggeli Constantina
First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Int J Cardiovasc Imaging. 2025 Mar;41(3):489-505. doi: 10.1007/s10554-025-03330-z. Epub 2025 Jan 22.
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.
A comprehensive literature search was performed using MEDLINE, Scopus and Web of Science electronic databases from their inception to November 2023.
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).
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.
心腔内超声心动图（ICE）似乎是经皮左心耳封堵术（LAAO）替代经食管超声心动图（TEE）的一种潜在选择。因此，进行了一项荟萃分析，比较ICE与TEE在LAAO引导中的应用。
使用MEDLINE、Scopus和Web of Science电子数据库，对从建库至2023年11月的文献进行全面检索。
纳入18项研究（124,230例患者）。与TEE引导相比，ICE引导下的技术成功率更高（OR：1.36，95%CI 1.14至1.63，p = 0.006），且使用的器械更少（SMD：-0.22，95%CI -0.43至-0.01，p = 0.04，I² = 62%）。ICE引导与更多的心包积液/心包填塞和医源性残余分流相关（对数RR：0.62，95%CI 0.36至0.89，p < 0.001；RR：1.53，95%CI 1.12至2.09，p = 0.02，I²分别为1%）。ICE组的血管并发症更多（对数RR：0.45，95%CI 0.11至0.78，p = 0.009）。
在LAAO中，ICE引导成像作为TEE的一种有效替代方法，考虑到技术成功率，其显示出比TEE更好的疗效。然而，应仔细考虑较高的不良事件发生率。
