Contemporary Imaging Modalities for Transcatheter Interatrial Communication Closure: A Comparative Meta-Analysis of Intracardiac and Transesophageal Echocardiography.

BACKGROUND: Intracardiac echocardiography (ICE) is increasingly used to guide cardiovascular interventions. This study compared the performance of ICE with transesophageal echocardiography (TEE) in device closures of interatrial communications. METHODS: A systematic search through PubMed, Scopus, Cochrane Library, and Europe PMC identified clinical studies directly comparing ICE and TEE as imaging guidance modalities for percutaneous closure of ASD or PFO in pediatric and adult populations. The key outcomes encompassed procedural time, fluoroscopy time, procedural success, complete closure at the latest follow-up, and major and minor complications. Pooled mean differences (MD) and risk ratios (RR) with corresponding 95% confidence intervals (CI) were measured by applying the random-effects model. RESULTS: Twelve studies comprising 5054 participants (ICE = 2480; TEE = 2574) were included in the quantitative analysis. Meta-analysis demonstrated a numerically shorter procedural time (MD -20.80 min; 95% CI -29.84 to -11.75; p < 0.00001), but not fluoroscopy time (MD -1.17 min; 95% CI -2.64 to 0.30; p = 0.12), in the ICE group compared with the TEE group. Procedural success rates and complete closure at the latest follow-up were comparable between both imaging strategies. In safety analyses, ICE was associated with a meaningful reduction of risk of major complications compared to TEE (RR 0.77; 95% CI 0.64 to 0.92; p = 0.004). Comparable findings were observed in the incidence of minor complications. CONCLUSION: ICE represents a promising alternative imaging modality for guiding transcatheter closure of ASD and PFO. Compared with TEE, ICE is associated with a numerically reduced procedural duration and a lower incidence of major complications, while maintaining comparable procedural success and long-term closure rates.