Reviews in Cardiovascular Medicine ![](https://rcm.imrpress.com/images/dao.gif)
2020,
Vol. 21 ![](https://rcm.imrpress.com/images/dao.gif)
Issue (1): 93-101
DOI: 10.31083/j.rcm.2020.01.569
Imaging with intracardiac echocardiography compared to transesophageal echocardiography during left atrial appendage occlusion
Guicheng Liang1, Beizhu Xu1, Shirong Wang1, Chengxuan Li1, Guoqiang Zhong1, *(
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)
1 Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, P. R. China.
Abstract:
We performed a meta-analysis comparing the procedural and outcomes data and related to left atrial appendage occlusion guided by intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) in nonvalvular atrial fibrillation patients. Technical success with ICE was significantly similar to that of TEE (odds ratio [OR] 1.38, 95% CI [0.62, 3.09], I2 = 0%, P = 0.43). The peri-procedural complications showed no significant difference between the two groups (OR 0.84, 95% CI [0.57, 1.23], I2 = 0%, P = 0.37). Mortality was similar in procedures using ICE vs TEE (OR 0.89, 95% CI [0.51, 1.57], I2 = 0%, P = 0.69). Landing zones, procedural time and fluoroscopic times between ICE and TEE showed no significant differences (MD 1.96, 95% CI [-0.01, 3.94], I2 = 90%, P = 0.05; MD -1.64, 95% CI [-13.45, 10.17], I2 =95%, P = 0.79; and MD 0.49, 95% CI [-2.18, 3.16], I2= 87%, P = 0.72, respectively). Imaging with ICE or TEE is associated with similar outcomes in left atrial appendage occlusion procedures.
Submitted: 29 September 2019
Accepted: 29 December 2019
Published: 30 March 2020
*Corresponding Author(s):
Guoqiang Zhong
E-mail: Zhgq17@163.com
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Guicheng Liang
Beizhu Xu
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Guoqiang Zhong
Figure 1. Flowchart of the processing of the included studies
Table 1. Baseline information of the included studies
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StudyYearCountryICETEEFollow-upPrimary endpointsMen, N (%)Age (years)Men, N (%)Age(years)Aguirre2018Chile13 (59.1)74 ± 9.313 (59.1)74 ± 9.330 daysdeath, pericardial effusion, MI, stroke, renal failure, length of hospital stayBerti2014Italy69 (57)77 ± 7.669 (57)77 ± 7.6within 24 hpericardial effusion, device embolization, stroke, bleeding, hematoma, othersBerti2018Italy123 (66)76 ± 8271 (65)74 ± 76, 12 monthsdeath, tamponade, stroke, TIA, systemic embolism, major bleeding, device embolizationClemente2015Italy78 ± 678 ± 65.2 ± 6 monthsresidual leaksFrangieh2017Switzerland26 (81)76 ± 8.925 (57)81 ± 7.4in hospitaldeath, tamponade, pericardial effusion, device embolization, stroke, peridevice leak, bleeding, renal failureFrikha2016Canada74.4 ± 7.674.4 ± 7.63 monthstamponade, MI, device embolization, stroke, hematomaHemam2019USA33 (62.3)77 ± 1031 (60.8)76 ± 745-120 ddeath, tamponade, device embolization, stroke, hematoma, peridevice flowHo, I2007USA8 (80)67.1 ± 8.48 (80)67.1 ± 8.412 monthsstrokes, transient ischemic attacksIwasawa2016USAnnnnndeath, tamponade, bleeding, hematomasKim2018Korea24 (58.5)71.4 ± 9.351 (49.5)72.3 ± 9.22 weeks, 3 monthsdeath, tamponade, pericardial effusion, stroke, MI, device embolization, air-embolization, thrombusKorsholm2017Denmark68 (62)73 ± 7.879 (74)73 ± 9.78 weeksdeath, pericardial effusion, device embolization, stroke, bleeding, hematoma, pseudoaneurysmMasson2015Canada25 (67.6)74.7 ± 8.225 (67.6)74.7 ± 8.23 monthstamponade, MI, bleedingMatsuo2016Czech11 (40.7)77.0 ± 8.511 (40.7)77.0 ± 8.545 ddeath, pericardial effusion, stroke, hematoma, othersNaim C2015Canada75 ± 875 ± 83 monthstamponade, device embolization, stroke, hematomaReis2018Portugal53 (64.6)74 ± 853 (64.6)74 ± 86-12 monthsdeath, tamponade, pericardial effusion, stroke, hematoma, bleeding
Table 2. Periprocedural complications
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StudyYearICETEEn = 823n = 1236Aguirre2018renal failure (1), Length of hospital (1)renal failure (1), Length of hospital (1)Berti2014Serious pericardial effusion (3), Procedure-related ischemic stroke (1), Femoral hematoma (2)Serious pericardial effusion (3), Procedure-related ischemic stroke (1), Femoral hematoma (2)Berti2018TIA (1), Device embolization (1), Pericardial tamponade (3), Major bleeding (3)Ischemic stroke (1), TIA (1), Device embolization (1), Pericardial tamponade (8), Major bleeding (16)Frangieh2017pericardial effusion (1)esophageal erosion with bleeding (1), non-LAAO related death (1)Frikha2016Tamponade (1), silent MI (1), hematoma (3)Tamponade (1), silent MI (1), hematoma (3)Iwasawa2016groin hematoma (2)cardiac tamponade (1), retro-peritoneal bleed (1), groin hematoma (2)Kim2018Pericardial effusion (1)Cardiac tamponade (1), Pericardial effusion (2), Device embolization (3), Vascular complications (1)Korsholm2017Pericardial effusion with tamponade (2), Access-site hematoma (3), Pseudoaneurysm (1)Device embolization n (1), Ischemic stroke (1), Hemorrhagic stroke (1), Major extracranial bleeding (2), Access-site hematoma (1)Masson2015Tamponade (1), Silent myocardial infarction (1), bleed (1)pulmonary embolism (1), heart failure (1), bleed (1)Matsuo2016pericardial effusion (1), hematoma (3), transient dizziness (1)Hematoma (3)
others(2)Naim C2015Tamponade (2), hematoma (2)residual leak (2), bleeding (2)Reis2018pericardial effusion (2), hematoma (1)residual leak (5), bleeding (4)Total5.6%6.5%
Table 3. Procedural endpoints
![](https://rcm.imrpress.com/images/table-icon.gif)
StudyYearLanding zone (mm)Procedural time (min)Fluoroscopic time (min)Contrast usage (ml)ICETEEICETEEICETEEICETEEBerti2018108 ± 3392 ± 3425 ± 1220 ± 11Clemente201521 ± 2.816.9 ± 3.7Frangieh201748 ± 14.834.5 ± 12.69.8 ± 4.67.9 ± 6.7485 ± 21.790 ± 63.7Hemam201921.27 ± 3.2721.5 ± 4.6846 ± 2446 ± 304.8 ± 2.77.3 ± 4.7Ho, I200722.6 ± 3.419.5 ± 1.5Iwasawa201653 ± 3157 ± 30Kim201826.0 ± 1.525.9 ± 1.458.0 ± 4.4480.0 ± 27.417.6 ± 3.788.3 ± 10.81Korsholm201744 ± 11.955 ± 28.115 ± 5.914 ± 8.960 ± 17.770 ± 20Masson2015105 ± 3425 ± 10155 ± 69Matsuo201623.7 ± 3.820.4 ± 5.42.98 ± 0.8Naim C201591.0 ± 28.1Reis201865.8 ± 15.269.9 ± 13.630.4 ± 17.035.1 ± 16.5
Table 4. , NOS quality assessment of the included studies
![](https://rcm.imrpress.com/images/table-icon.gif)
StudySelectionComparabilityOutcomeAguirre★★★★★★Berti 2014★★★★★Berti 2018★★★★★★★Clemente★★★★★Frangieh★★★★★Frikha★★★★★★Hemam★★★★★★★Ho, I★★★★★★★Iwasawa★★★Kim★★★★★★Korsholm★★★★★★★Masson★★★★★★Matsuo★★★★★★Naim C★★★★★★Reis★★★★★★★
Figure 2. Forest plot of the technical success of ICE vs TEE.
Figure 3. Forest plot of periprocedural complications.
Figure 4. Funnel plot of periprocedural complications.
Figure 5. Forest plot of the measurements of the LZ for ICE vs TEE. Random effects model.
Figure 6. Forest plot of the procedural time for ICE vs TEE. Random effects model.
Figure 7. Forest plot of the fluoroscopic time for ICE vs TEE. Random effects model.
Figure 8. ICE guidance for LAAO. (A) Interatrial septal puncture (ICE probe in the right atrium); (B) visualization of the LAA and anatomy assessment (ICE probe in the left atrium); (C) device position assessment; (D) check for peri-device flow/leak with color Doppler-flow imaging. LAA: left atrial appendage; LA: left atrium; RA: right atrium; W: Watchman device.
Figure 9. TEE guidance for LAAO. (A) Interatrial septal puncture; (B) visualization of the LAA and anatomy assessment; (C) device position assessment; (D) check for peri-device flow/leak with color Doppler-flow imaging (the red color indicates the flow toward the left atrium and not a leak since the flow is a lower velocity and no peri-device penetration detected). LAA: left atrial appendage; LA: left atrium; MV: mitral valve; RA: right atrium; W: Watchman device.
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