Intracardiac Versus Transesophageal Echocardiography for Left Atrial Appendage Occlusion: A Meta-Analysis

The optimal imaging modality for guiding left atrial appendage occlusion remains unclear.

The authors compared the effectiveness and safety of intracardiac echocardiography (ICE) vs transesophageal echocardiography (TEE) during left atrial appendage occlusion.

Electronic databases were searched through November 2025 for studies that compared procedural success and safety with ICE vs TEE. We pooled data using a random-effects model to calculate ORs for categorical outcomes and mean differences (MDs) for continuous variables. A subgroup analysis was performed for unadjusted and adjusted data.

The meta-analysis included 27 observational studies, of which 9 studies reported adjusted summary estimates. Procedural success was comparable in both groups (unadjusted OR: 1.16; 95% CI: 0.92-1.45, I² = 0%; adjusted OR: 1.40; 95% CI: 0.99-1.98, I² = NA). ICE was associated with significantly shorter procedure duration in the adjusted analyses (MD -20.76 minutes; 95% CI: -26.99 to -14.53, I² = 0%), though no difference was observed in unadjusted analyses (MD -0.13; 95% CI: -5.40 to 5.14, I² = 95%). ICE was associated with a higher incidence of in-hospital pericardial effusion requiring intervention (unadjusted OR: 1.52; 95% CI: 1.13-2.04, I² = 9%; adjusted OR: 1.74; 95% CI: 1.15-2.64, I² = 8%). ICE was associated with a higher incidence of residual iatrogenic atrial septal defect at <4 months (unadjusted OR: 1.61; 95% CI: 1.20-2.16, I² = 0%).

ICE and TEE demonstrated comparable procedural success. However, ICE was associated with shorter procedural duration at the expense of a higher incidence of intervention-requiring pericardial effusion and residual iatrogenic atrial septal defect. (Intracardiac versus Transesophageal Echocardiography for Left Atrial Appendage Occlusion: A Meta-Analysis Stratified by Adjusted and Unadjusted Subgroups; CRD420251243170).