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Evaluating the role of transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) in left atrial appendage occlusion: a meta-analysis

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Abstract

Purpose

Intracardiac echocardiography (ICE) is increasingly common among periprocedural imaging modalities used during complex cardiac procedures. We sought to perform a meta-analysis comparing transesophageal echocardiography (TEE) and ICE in endocardial left atrial appendage occlusion (LAAO).

Methods

We searched PubMed and Google Scholar regarding abstracts and manuscripts using keywords: atrial fibrillation, left atrial appendage occlusion, Watchman, Amplatzer Cardiac Plug, Amulet, intracardiac echocardiography, and transesophageal echocardiography from their inception to July 12, 2019. Data extraction was performed using standard form for the following: title, year of publication, sample size, comorbid conditions, LAAO device, type of pre-procedural imaging, intraprocedural imaging, and clinical outcomes including the following: acute procedural success, fluoroscopy, and total procedure time and complications.

Results

A total of 42 relevant studies were screened resulting in inclusion of 8 observational studies comparing TEE and ICE in endocardial LAAO. Outcomes assessed including procedural success (RR 1.00, 95% CI (0.97–1.03, p = 0.98)), complications (RR 0.77, 95% CI (0.52 to 1.15, p = 0.20)), fluoroscopy time (mean difference − 0.40, 95% CI (−3.12–2.32, p = 0.77)), and procedural time (mean difference − 8.02, 95% CI (−22.81 to 6.76, p = 0.29)) were found to be similar between both groups.

Conclusions

While TEE is the gold standard for perioperative imaging with LAAO, ICE is a feasible and safe alternative that reduces exposure to general anesthesia and associated potential risks.

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Authors and Affiliations

  1. The Kansas City Heart Rhythm Institute (KCHRI) HCA MidWest, Overland Park Regional Medical Center, 12200 W 106th Street, Overland Park, KS, 66215, USA

    Krishna Akella, Ghulam Murtaza, Rakesh Gopinathannair & Dhanunjaya Lakkireddy

  2. Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Mohit Turagam

  3. Department of Cardiology, Garden City Hospital, Garden City, MI, USA

    Sharan Sharma

  4. Department of Internal Medicine, Overland Park Regional Medical Center, Overland Park, KS, USA

    Bader Madoukh

  5. Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA

    Anish Amin

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  1. Krishna Akella
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  2. Ghulam Murtaza
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  3. Mohit Turagam
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  4. Sharan Sharma
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  5. Bader Madoukh
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  8. Dhanunjaya Lakkireddy
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Corresponding author

Correspondence to Dhanunjaya Lakkireddy.

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Conflict of interest

DL: Consultant to Johnson & Johnson, Abbott, Biotronik, Pfizer, Boston Sci.

RG: Consultant/speaker: Abbott Medical, Boston Scientific, Zoll Medical, Pfizer, Bristol Myers Squibb; Physician advisor: HealthTrust PG, Abiomed.

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Akella, K., Murtaza, G., Turagam, M. et al. Evaluating the role of transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) in left atrial appendage occlusion: a meta-analysis. J Interv Card Electrophysiol 60, 41–48 (2021). https://doi.org/10.1007/s10840-019-00677-x

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  • DOI: https://doi.org/10.1007/s10840-019-00677-x

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