Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta-analysis

Aims We performed a meta-analysis to compare the safety and efficacy of intracardiac echocardiography (ICE) vs transoesophageal echocardiography (TOE) for the guidance of percutaneous left atrial appendage occlusion (LAAO). Methods and Results A comprehensive search of the literature was performed, from inception to December 2018 using MEDLINE, Cochrane Library, and Google Scholar electronic databases, and references from articles. Publications comparing ICE and TOE for the guidance of percutaneous LAAO were included in the analysis. The co-primary endpoints were procedural success and procedure-related complications. Secondary endpoints included procedural and fluoroscopy times and the volume of contrast media used. Five studies were included in the analysis, providing a total of 1122 patients. Procedural success was similar with both techniques (pooled odd ratio [OR] 1.46, 95% confidence interval [CI] 0.77-2.75, P = 0.24, I-2 = 0%), with a trend for less procedure-related complications in the ICE group (pooled OR 0.57, 95% CI 0.31-1.05, P = 0.07, I-2 = 0%). Neither procedural (mean difference -1.64 minutes, 95% CI -16.42 to 13.14, P = 0.83, I-2 = 96%) nor fluoroscopy times (mean difference + 1.29 minutes, 95% CI -1.38 to 3.97, P = 0.34, I-2 = 76%) varied significantly between groups. There was a reduction in the volume of contrast media used in the ICE group (mean difference -9.71 mL, 95% CI -14.61 to -4.81, P > 0.01, I-2 = 0%). Conclusion Intracardiac echocardiography is a safe and effective alternative to TOE for guidance of percutaneous LAAO.