Khan Ubaid, Amin Ahmed Mazen, Majeed Zuhair, Khan Muhammad Haris, Shaaban Abdelgalil Mahmoud, Mubariz Muhammad, Ramadan Shrouk, Imran Muhammad, Raza Ahmed, Rehman Muhammad Naveed Ur, Bukhari Syed Hassnain Zafar, Asif Ahmad Talal, Gunjial Fahad Hassan, Ali Junaid, Nawaz Anum
Division of Cardiology University of Maryland School of Medicine Baltimore Maryland USA.
Faculty of Medicine Mansoura University Mansoura Egypt.
J Arrhythm. 2025 Jul 1;41(4):e70115. doi: 10.1002/joa3.70115. eCollection 2025 Aug.
Intracardiac echocardiography (ICE) is an innovative technique that has emerged as an alternative to transesophageal echocardiography (TEE) to guide the implantation of a left atrial appendage occlusion (LAAO) device in patients with nonvalvular atrial fibrillation (AF) who cannot tolerate anticoagulants.
We aim to review the clinical efficacy and safety of ICE compared to TEE to guide the implantation of LAAO devices in patients with AF.
We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and EMBASE until March 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024542537.
We included 19 studies involving 44,706 patients. ICE was associated with a statistically significant high procedure success rate compared to TEE (RR: 1.0055 with 95% CI [1.0006, 1.0104], = 0.01), but there was no difference in procedure duration (MD: 3.07 with 95% CI [-4.67, 10.80], = 0.44) between the two groups. However, compared to the ICE group, patients undergoing LAAO under TEE guidance required more than one device more often (RR: 1.39 with 95% CI [1.23, 1.57], < 0.01). The TEE group also reported a reduced incidence of pericardial effusion compared to the ICE group (RR: 0.65 with 95% CI [0.50, 0.85], < 0.01).
Our meta-analysis concluded that ICE can be a viable alternative to TEE for guiding LAAO, particularly in patients unsuitable for general anesthesia. It can also reduce the need for GA and adverse effects and resources associated with it, require fewer devices, and demonstrate comparable safety and efficacy outcomes, though it may increase the risk of pericardial effusion. Further prospective trials are warranted.
心腔内超声心动图（ICE）是一种创新技术，已成为经食管超声心动图（TEE）的替代方法，用于指导无法耐受抗凝治疗的非瓣膜性心房颤动（AF）患者植入左心耳封堵（LAAO）装置。
我们旨在回顾与TEE相比，ICE指导AF患者植入LAAO装置的临床疗效和安全性。
我们在PubMed、CENTRAL、科学网、Scopus和EMBASE上进行了全面检索，直至2024年3月。汇总数据以二分类结局的风险比（RR）和连续结局的平均差（MD）报告，并伴有95%置信区间（CI）。本系统评价和荟萃分析已在PROSPERO注册，注册号：CRD42024542537。
我们纳入了19项研究，涉及44706例患者。与TEE相比，ICE的手术成功率在统计学上显著更高（RR：1.0055，95%CI[1.0006，1.0104]，P=0.01），但两组的手术持续时间无差异（MD：3.07，95%CI[-4.67，10.80]，P=0.44）。然而，与ICE组相比，在TEE指导下进行LAAO的患者更常需要不止一个装置（RR：1.39，95%CI[1.23，1.57]，P<0.01）。与ICE组相比，TEE组心包积液的发生率也更低（RR：0.65，95%CI[0.50，0.85]，P<0.01）。
我们的荟萃分析得出结论，ICE可以作为TEE指导LAAO的可行替代方法，特别是对于不适合全身麻醉的患者。它还可以减少全身麻醉的需求以及与之相关的不良反应和资源，所需装置更少，并显示出相当的安全性和疗效结果，尽管它可能会增加心包积液的风险。有必要进行进一步的前瞻性试验。
