Intracardiac echocardiography as transesophageal echocardiography replacement in percutaneous intervention imaging: a systematic review and meta-analysis

Abstract Background Intracardiac echocardiography (ICE) has become more popular as an alternative to transesophageal echocardiography (TEE), the current gold standard modality of intraoperative imaging in percutaneous closure of interatrial communications, despite the limited three-dimensional capabilities and operational learning curve. ICE's primary strength is the lack of general anaesthesia, thus reducing the risk from airway intervention. Studies have shown that the successful device deployment rate assisted with ICE was similar to TEE. In addition, the optimal use of ICE has been suggested to lower procedural and fluoroscopy time, leading to better outcomes. However, there is currently limited evidence in this area to support ICE as the better option for imaging in percutaneous atrial septal intervention. Purpose To compare the total procedural time and fluoroscopy exposure between ICE versus TEE for the guidance of percutaneous atrial septal intervention. Methods We performed a comprehensive literature search using PUBMED and Google Scholar from inception to December 2020. Publications that compared ICE and TEE in the atrial septal intervention in adult patients were screened according to our eligibility criteria. The primary outcome of the study was procedural time. Analysis was performed using Revman 5.4. Results Five studies were included in this study, providing a total of 332 (ICE=169 VS TEE=163) patients. The mean procedural time was shorter in the ICE group compared to the TEE group (mean differences −8.67 minutes, 95% CI: −10.48 to −6.86, p<0.0001, I2=95%). The mean fluoroscopy exposure was also shorter in the ICE group (mean differences −3.22 minutes, 95% CI: −3.73 to −2.71, p<0.0001, I2=87%). There was no difference in term of success rate of the closure nor significant complications during peri-procedural reported in all studies. Conclusion ICE-assisted intervention was shown to be more efficient and associated with statistically significant shorter procedure time and fluoroscopy time than TEE, reducing the possible risk for side effects. Therefore, our analysis suggested that ICE could replace TEE as primary guidance of percutaneous atrial septal intervention. Funding Acknowledgement Type of funding sources: None.