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Impact Of Intracardiac Echocardiography Vs. Transesophageal Echocardiography Guidance On Left Atrial Appendage Occlusion Procedures: A Meta-Analysis
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  • Juan Carlos Diaz,
  • Oriana Bastidas,
  • Mauricio Duque,
  • Jorge Marin,
  • Julian Aristizabal,
  • Cesar Niño,
  • Carolina Hoyos-Ochoa,
  • Carlos D. Matos,
  • Mohamed Gabr,
  • Nathaniel Steiger,
  • Sunil Kapur,
  • William H. Sauer,
  • Jorge Romero
Juan Carlos Diaz
Clinica Las Vegas

Corresponding Author:jcdiaz1234@hotmail.com

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Oriana Bastidas
Hospital Pablo Tobon Uribe
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Mauricio Duque
Hospital Universitario San Vicente de Paul
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Jorge Marin
Clinica Las Americas
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Julian Aristizabal
Hospital Universitario San Vicente de Paul
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Cesar Niño
Hospital Pablo Tobon Uribe
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Carolina Hoyos-Ochoa
Brigham and Women's Hospital
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Carlos D. Matos
Brigham and Women's Hospital
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Mohamed Gabr
Brigham and Women's Hospital
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Nathaniel Steiger
Brigham and Women's Hospital
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Sunil Kapur
Brigham and Women's Hospital
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William H. Sauer
Brigham and Women's Hospital
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Jorge Romero
Brigham and Women's Hospital
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Abstract

Background: Intracardiac echocardiography (ICE) is increasingly used during left atrial appendage occlusion (LAAO) as an alternative to transesophageal echocardiography (TEE) Aim: To evaluate the impact of ICE vs. TEE guidance during LAAO on procedural characteristics and acute outcomes, as well the presence of peri-device leaks and residual septal defects during follow-up. Methods: All studies comparing ICE-guided vs. TEE-guided LAAO were identified. The primary outcomes were procedural efficacy and occurrence of procedure-related complications. Secondary outcomes included lab efficiency (defined as a reduction in in-room time), procedural time, fluoroscopy time, and presence of peri-device leaks and residual interatrial septal defects (IASD) during follow-up. Results: Twelve studies (n=5637) were included. There were no differences in procedural success group (98.3% vs. 97.8%; OR 0.73, 95% CI 0.42-1.27, p=0.27; I2=0%) or adverse events (4.5% vs. 4.4%; OR 0.81 95% CI 0.56-1.16, p=0.25; I2=0%) between the ICE-guided and TEE-guided groups. ICE guidance reduced in in-room time (mean-weighted 28.6-minute reduction in in-room time) without differences in procedural time or fluoroscopy time. There were no differences in peri-device leak (OR 0.93, 95% CI 0.68-1.27, p=0.64); however, an increased prevalence of residual IASD was observed with ICE-guided vs. TEE-guided LAAO (46.3% vs. 34.2%; OR 2.23, 95% CI 1.05-4.75, p=0.04). Conclusion: ICE guidance is associated with similar procedural efficacy and safety, but could result in improved lab efficiency (as established by a significant reduction in in-room time). No differences in the rate of periprocedural leaks were found. A higher prevalence of residual interatrial septal defects was observed with ICE guidance.
21 Sep 2023Submitted to Journal of Cardiovascular Electrophysiology
21 Sep 2023Review(s) Completed, Editorial Evaluation Pending
21 Sep 2023Submission Checks Completed
21 Sep 2023Assigned to Editor
21 Sep 2023Reviewer(s) Assigned
13 Oct 2023Editorial Decision: Revise Minor
16 Oct 20231st Revision Received
16 Oct 2023Submission Checks Completed
16 Oct 2023Assigned to Editor
16 Oct 2023Review(s) Completed, Editorial Evaluation Pending
16 Oct 2023Reviewer(s) Assigned
20 Oct 2023Editorial Decision: Accept