GUO Qiong 1 , ZHAO Qingwen 2 , GU Xianlin 2 , JIANG Guiyu 2 , FENG Kun 3 , LONG Youlin 1,3 , LIN Yifei 1,4 , HUANG Jin 1,3 , DU Liang 1,3,5
  • 1. Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
  • 2. West China School of Public Health, Sichuan University, Chengdu, 610044, P. R. China;
  • 3. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
  • 4. Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
  • 5. West China Periodical Press, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
HUANG Jin, Email: michael_huangjin@163.com; DU Liang, Email: duliang0606@vip.sina.com
Intracardiac echocardiography; transesophageal echocardiography; left atrial appendage closure; meta-analysis; systematic review
10.7507/1007-4848.202208045
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Objective  To systematically evaluate the safety, efficacy, and economics of intracardiac echocardiography (ICE) versus transesophageal echocardiography (TEE) in left atrial appendage occlusion (LAAO). Methods  PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Database were systematically searched to collect relevant studies on comparing ICE and TEE-guided LAAO from inception to June 15th, 2022. Two reviewers independently screened the literatures, extracted the data, and assessed the risk of bias of the included studies. Meta-analyses were performed using RevMan 5.3 and R 4.0.3. Retrospective cohort studies were excluded for sensitivity analysis. Subgroup analyses were performed based on the types of occluder and ICE catheter. Results  A total of 14 studies with 6 599 patients were included. Meta-analyses showed no statistical differences in technical success rate, overall complications, device embolization, peri-device leakage, device-related thrombus, stroke, vascular complications, bleeding, operation time, fluoroscopy time, or contrast agent volume between the ICE and TEE-guided LAAO. The total in-room time (MD=–33.47 min, 95%CI –41.20 to –25.73, P<0.00001) and radiation dosage (MD=–170.20 mGy, 95%CI –309.79 to –30.62, P=0.02) were lower in the ICE group than those in the TEE group, whereas the incidence of pericardial effusion/tamponade was higher than the TEE group (RR=1.57, 95%CI 1.01 to 2.45, P=0.048). Except for pericardial effusion/tamponade, subgroup analyses and sensitivity analysis showed similar results. The analysis based on the cost data from the United States showed comparable or even lower total costs for ICE versus TEE, but comparative domestic cost studies were lacking. Conclusion  Current evidence suggests that ICE-guided LAAO can reduce radiation dosage and total in-room time, and there is no statistical difference in the overall complication rate between the two groups. Owing to the limitations of sample size and quality of the included studies, the conclusion still needs to be verified by large sample size and high-quality randomized controlled trials.

Citation： GUO Qiong, ZHAO Qingwen, GU Xianlin, JIANG Guiyu, FENG Kun, LONG Youlin, LIN Yifei, HUANG Jin, DU Liang. Intracardiac echocardiography versus transesophageal echocardiography for left atrial appendage occlusion: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1492-1502. doi: 10.7507/1007-4848.202208045 Copy

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