Aug 2026· European Heart Journal-Cardiovascular Imaging· 0 citations
Medicine
TL;DR
This meta-analysis indicates that ICE is a safe, effective, and non-inferior alternative to TEE for patients undergoing AF ablation ± LAAC, however, TEE remains an effective tool for detecting LAA thrombus.
Abstract
Background
Intracardiac echocardiography (ICE) is a valuable, real-time imaging tool in structural cardiology and electrophysiology, performed without general anesthesia. However, its safety compared to transesophageal echocardiography (TEE) remains unclear.
Objective
To conduct a meta-analysis evaluating outcomes of catheter ablation for atrial fibrillation (AF) with or without left atrial appendage closure (LAAC) guided by TEE versus ICE.
Methods
Databases were searched for studies comparing ICE with TEE guidance during AF ablation ± LAAC. Outcomes were pooled using the Inverse-Variance (IV) random-effects model in R, with risk ratios (RRs) for dichotomous variables and mean or standardized mean differences (MD or SMD) for continuous variables, and 95% confidence intervals (CIs) reported.
Results
We included 8 studies involving 7,671 patients, of whom 3,903 (50.9%) underwent procedures with ICE guidance. There were no significant differences between groups in cardiac tamponade risk (RR 0.86; 95% CI 0.44-1.66; p = 0.39), stroke or TIA (RR 1.00; 95% CI 0.39-2.55; p = 0.57), vascular complications (RR 0.80; 95% CI 0.51-1.25; p = 0.37). ICE was associated with lower pre-procedure LAA thrombus detection (RR 0.32; 95% CI 0.11-0.94; p = 0.04), radiation dose (SMD -0.47; 95% CI -0.90 to -0.04; p = 0.03), and fluoroscopy time (-4.25 mins; 95% CI -6.01 to -2.49; p < 0.01) but the procedure duration was significantly lower only in combined AF ablation + LAAC (MD -19.56 mins; 95% CI -24.15 to -14.97; p < 0.01).
Conclusion
This meta-analysis indicates that ICE is a safe, effective, and non-inferior alternative to TEE for patients undergoing AF ablation ± LAAC. However, TEE remains an effective tool for detecting LAA thrombus.
BACKGROUND
Atrial fibrillation (AF) carries a substantial ischemic stroke risk originating predominantly from the left atrial appendage (LAA). Catheter ablation (CA) is the most effective rhythm-control strategy, while percutaneous LAA closure (LAAC) provides mechanical stroke prophylaxis. Combining both in a single one-stop procedure is increasingly performed, yet data on its rhythmic and periprocedural consequences remain scarce.
METHODS
We performed a systematic review and meta-analysis to compare the efficacy and safety of combined CA + LAAC versus CA-only in patients with AF. PubMed, Scopus and Web of Science were searched through June 12th 2026. The primary efficacy and safety outcomes were arrhythmia recurrence and periprocedural pericardial effusion requiring drainage, respectively. Binary endpoints were pooled as odds ratios (OR), continuous endpoints as mean differences (MD), using a random-effects model with heterogeneity reported as I2.
RESULTS
Fourteen studies comprising 3,274 patients (1,505 CA + LAAC; 1,769 CA-only) were included. Arrhythmia recurrence was significantly more frequent after combined CA + LAAC (OR = 1.56, 95% CI = 1.11-2.19, I2 = 47%). Systemic thromboembolism was numerically lower but did not differ significantly (OR = 0.66, 95% CI = 0.37-1.21, I2 = 0%). Total procedure time was significantly longer for the combined procedure (MD = + 9.34 min, 95% CI = 0.63-18.05, I2 = 90%). Periprocedural pericardial effusion requiring drainage did not differ between groups (OR = 1.19, 95% CI = 0.59-2.44, I2 = 0%).
CONCLUSION
Combined CA + LAAC was associated with significantly higher arrhythmia recurrence than CA-only, potentially attributable to limited substrate modification in the one-stop setting. The primary safety outcome, pericardial effusion requiring drainage, did not differ between groups. Randomised controlled trials are warranted to confirm these findings.
Isabel Rattka, C. Poch, Tabea Deichsel et al.· Journal of interventional ca...· 0 citations
Intracardiac echocardiography (ICE) is an alternative to transesophageal echocardiography for imaging guidance during left atrial appendage occlusion (LAAO) in patients with atrial fibrillation with intolerance to long-term oral anticoagulation. This narrative review synthesizes contemporary evidence on ICE-guided LAAO. Across observational studies, ICE provides real-time high-resolution imaging enabling accurate trans-septal puncture, device sizing, and deployment under conscious sedation. Procedural success, peri-device leak, and device-related thrombus rates appear comparable between ICE- and TEE-guided LAAO, while ICE may also shorten fluoroscopy time and avoid general anesthesia. Challenges with ICE include operator learning curve, need for additional venous access and intracardiac catheter manipulation, that may add to risks like pericardial effusions, vascular complications and higher costs. Emerging 3D/4D ICE and artificial-intelligence-integrated computed tomographic planning may improve efficiency and allow for combined ablation and LAAO procedures. Further randomized controlled trials and cost-effectiveness studies are needed to define the role of ICE-first approach.
C. Gahona, R. Vempati, Quang Dat Ha et al.· Pacing and clinical electrop...· 0 citations
INTRODUCTION
The adoption of vascular closure devices (VCDs) has gained prominence as an alternative to standard care (SC) for patients undergoing atrial fibrillation (AF) ablation. Although VCDs present potential benefits, there are ongoing concerns related to the duration required for hemostasis, the time until patient discharge, and the incidence of vascular complications. Therefore, we conducted a systematic review and meta-analysis to assess the outcomes associated with VCDs compared to SC.
METHODS
We systematically searched the PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) and non-RCTs, comparing VCD with SC in patients who underwent AF ablation. Statistical analyses were performed using R 4.0.0. Heterogeneity was assessed using I2. We pooled the mean difference (MD) and odds ratio (OR) with 95% confidence intervals (CIs). Statistical significance was set at P < 0.05. The main continuous outcomes of interest included the time to hemostasis, the time until discharge, and the occurrence of minor vascular complications.
RESULTS
A total of two RCTs and five cohort studies involving 30,560 patients were included. Of these, 15,343 (50%) received treatment with VCDs, and 15,217 (49.7%) received SC. The follow-up period varied from 1 wk to 3 mo. Patient ages varied from 58 to 66 y on average. VCDs had a shorter time to hemostasis than SC (MD = -5.63 min; 95% CI -7.30 to -3.95; P < 0.01; I2 = 99%). There was no difference in the two groups regarding time until discharge (MD = -10.68 h; 95% CI -21.98 to 0.63; P = 0.06; I2 = 100%). No statistical difference was found in the OR for minor vascular complications (OR 0.96, 95% CI 0.29-3.13; P = 0.941; I2 = 55%) and same-day discharge (OR 4.37, 95% CI 0.69-27.76; P = 0.118; I2 = 81%) between the two groups.
CONCLUSIONS
In patients with AF undergoing ablation, VCDs achieve homeostasis more rapidly than SC, with no significant difference observed between the two groups in terms of time to discharge, minor vascular complications, and same-day discharge.
Nimra Farid, Pedro Bicudo Bergion, Henrique de Carvalho Lacerda et al.· Journal of Surgical Research· 0 citations
TTE is recommended as the first-line CRAT screening tool for MHD patients and combined TTE and DSA use improves diagnostic yield, and regular targeted surveillance for high-risk individuals reduces CRAT incidence.
Fen Yu, Xiaomei Huang, Jing-Jing Liu et al.· Journal of Clinical Medicine· 0 citations
BACKGROUND
Permanent pacemaker implantation is required in up to 25% of patients after transcatheter aortic valve replacement (TAVR). Conventional right ventricular pacing (RVP) may promote dyssynchrony, whereas conduction system pacing (CSP) preserves physiological activation.
RESEARCH QUESTION
Does CSP improve clinical, echocardiographic, electrical, and procedural outcomes compared with RVP in patients requiring pacing after TAVR?
METHODS
We conducted a PROSPERO-registered systematic review and meta-analysis following PRISMA 2020. PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through June 2026 for randomized and comparative observational studies of CSP versus RVP after TAVR. Random-effects models generated risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Prediction intervals, cumulative meta-analysis, leave-one-out analyses, and GRADE assessment were performed.
RESULTS
Six studies, one randomized trial and five observational studies, enrolled 675 patients (CSP, n = 344; RVP, n = 331). CSP was associated with fewer heart-failure hospitalizations (RR 0.49, 95% CI 0.29-0.83; p = 0.017; I2 = 5%) and shorter paced QRS duration (MD -31.05 ms, 95% CI -34.07 to -28.02; p < 0.001; I2 = 0%). All-cause mortality, cardiovascular death, and change in left ventricular ejection fraction did not differ significantly. Implantation success was modestly lower with CSP (RR 0.91; p = 0.014).
CONCLUSION
CSP was associated with fewer heart-failure hospitalizations and shorter paced QRS duration than RVP after TAVR. Evidence was predominantly observational, and no significant differences were demonstrated in mortality or change in left ventricular ejection fraction. The potential clinical relevance of CSP when a high ventricular pacing burden is anticipated remains plausible but was not directly demonstrated by the available data; adequately powered randomized trials are required before routine adoption.
R. Shakeel, A. Uddin, D. Ladhani et al.· Pacing and clinical electrop...· 0 citations
Background: WATCHMAN and Amplatzer Amulet devices are an effective alternative to oral anticoagulation for left atrial appendage closure (LAAC) in non-valvular atrial fibrillation (NVAF) patients. This study aims to compare their safety and efficacy. Methods: This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, and ScienceDirect, were searched from inception to May 2025 for comparative studies in NVAF patients. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed via I2 statistic; statistical significance was at P < 0.05. Results: Sixteen studies were included. No significant differences were found in ischemic stroke (RR 1.10, 95% CI 0.83–1.46; P = 0.51; I2 = 0%), all-cause mortality (RR 0.92, 95% CI 0.75–1.14; P = 0.45; I2 = 0%), major bleeding (RR 1.11, 95% CI 0.90–1.38; P = 0.33; I2 = 0%), minor bleeding (RR 1.11, 95% CI 0.76–1.61; P = 0.59; I2 = 22%), cardiac mortality (RR 0.86, 95% CI 0.39–1.93; P = 0.72; I2 = 51%), major procedure-related complications (RR 0.93, 95% CI 0.44–1.96; P = 0.55; I2 = 62%), cardiac tamponade (RR 0.57, 95% CI 0.25–1.29; P = 0.18; I2 = 30%), device embolization (RR 0.74, 95% CI 0.30–1.86; P = 0.53; I2 = 0%), vascular complications (RR 0.74, 95% CI 0.34–1.52; P = 0.38; I2 = 0%), or peridevice leak (RR 0.88, 95% CI 0.56–1.36; P = 0.55; I2 = 77%). WATCHMAN showed higher device thrombosis (RR 1.73, 95% CI 1.20–2.49; P = 0.003; I2 = 0%) but lower pericardial effusion (RR 0.47, 95% CI 0.29–0.76; P = 0.002; I2 = 0%). Conclusions: WATCHMAN and Amulet demonstrate no significant difference in efficacy and safety for most LAAC outcomes, including stroke and major bleeding. However, WATCHMAN is associated with a significantly lower risk of pericardial effusion but a higher risk of device thrombosis.
Samir Shamieh, Barakat Alsaqqa, Armstrong Nicholas Kpachi et al.· Annals of Medicine and Surge...· 0 citations
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