CE-452771-1 IMPACT OF INTRACARDIAC VS. TRANSESOPHAGEAL ECHOCARDIOGRAPHY GUIDED LEFT APPENDAGE CLOSURE ON PROCEDURAL CHARACTERISTICS AND LAB EFFICIENCY: A META ANALYSIS

Abstract

Left atrial appendage occlusion (LAAO) is frequently performed under transesophageal echocardiography (TEE) guidance, but intracardiac echocardiography (ICE) is increasingly being used given its ease of use and the possibility to perform the procedure under light sedation (as opposed to general anesthesia). The impact of ICE vs. TEE guidance on procedural characteristics and lab efficiency is yet to be determined. To evaluate the impact of ICE vs. TEE guidance during LAAO on procedural efficacy and safety; fluoroscopy procedural and in room time; and the presence of peridevice leaks and residual septal defects during follow-up. Pubmed, Embase and Cochrane were searched using the term "left atrial appendage" AND (closure OR occlusion) AND "intracardiac echocardiography". No language restriction was applied. Single arm studies, review articles, abstracts, letters to the editor and studies using database claims were excluded. All articles were evaluated by 3 independent reviewers (JCD, OB, JR) and the risk of bias established using the Newcastle-Ottawa scale with a score >6 considered a high-quality study; differences were solved by consensus. Statistical analysis was performed using Revman 5.4 (Cochrane collaboration). Eleven observational studies (n=3034; 976 using ICE guided LAAO) were included. Nine studies were considered high quality, with 2 studies having a score of 6. There were no statistically significant differences in procedural success (OR 1.38 95% CI 0.76-2.51, p=0.29) or procedure related major adverse events (OR 0.77 95% CI 0.53-1.12) in ICE guided vs. TEE guided LAAO. The use of ICE guidance resulted in a statistically significant reduction in in-room time (mean difference -35.5 minutes; 95% CI -44.9 to -26 min. p <0.0001). No significant differences were found in procedural time or fluoroscopy time. During follow-up imaging, there were no differences in peridevice leak (OR 0.9 95% CI 0.66-1.23). A trend towards increased prevalence of residual interatrial septal defects was observed with ICE guided vs. TEE guided LAAO (OR 1.43, 95% CI 0.99-2.07, p =0.05). ICE guidance is associated with improved lab efficiency (as established by a significant 35-minute reduction in in-room time), without any significant differences in procedural success or safety. During follow-up, there were no differences of the rate of periprocedural leaks. A non-significant trend towards a higher prevalence of residual interatrial septal defects was observed.