Systematic evaluation and meta-analysis of transcardiac intracavitary and transesophageal echocardiography-guided left atrial appendage occlusion surgery

Objective: To systematically evaluate the differences in safety, efficacy, and economics between intracardiac ultrasound (ICE) and transesophageal echocardiography (TEE)-guided LAAO (LAAO), and to provide an evidence-based rationale for the selection of clinical image-guided modalities. Methods: PubMed, Embase, Cochrane Library, Web of Science and Wanfang databases were searched to include randomized controlled trials and observational studies comparing ICE with TEE-guided LAAO, strictly following PRISMA guidelines. Two investigators independently screened the literature, extracted data and assessed the risk of bias (ROBINS-I and Cochrane tools). Meta-analysis was performed using RevMan 5.4.1, and the outcome indicators included technical success, procedure time, contrast dose, fluoroscopy time, complications, and economic parameters, and subgroup analyses were performed to explore the effects of factors such as patient characteristics and instrument type. Results: = 0.43). Subgroup analysis showed. Operative efficiency: < 0.001). Disease characteristics: < 0.001). Economics: > 90%) mainly stemming from differences in study design and device type. Conclusion: The core clinical outcomes (success and safety) of ICE and TEE in LAAO are equivalent, but operational efficiency is moderated by patient age, LV morphology, and device design. ICE is recommended for young, anatomically simple patients at high risk for anesthesia, and individualized decision-making needs to be optimized with team experience and health economic assessment. Future multicenter RCTs and cost-utility analyses are needed to validate long-term benefits. Systematic Review Registration: PROSPERO CRD42024626272.