Intracardiac Versus Transesophageal Echocardiography for diagnosis of Left Atrial Appendage Thrombosis in Atrial Fibrillation: a Meta-analysis

Introduction: Left atrial appendage (LAA) thrombus in patients with atrial fibrillation is usually detected by transesophageal echocardiography (TEE). Intracardiac echocardiography (ICE) can be a suitable alternative to detect thrombosis. We performed a meta-analysis of all studies that compared ICE vs. TEE for LAA thrombosis. Methods: : We searched PubMed, Cochrane Library, and Embase for published abstracts and manuscripts until June 1, 2020. Studies reporting clinical outcomes comparing TEE vs. ICE for LAA thrombus in human subjects aged ≥ 18 years were included. Two investigators independently extracted the data and an individual quality assessment was performed. The analysis was performed using RevMan 5.3, STATA 15, and Meta-Disc 1.4. Results: : Eight eligible studies consisting of 1108 patients (TEE = 558 vs. ICE = 550) were included. The average sensitivity of ICE and TEE to diagnose left atrial appendage thrombus was 1.0 (95% CI: 0.91-1.00) vs 0.68 (95% CI: 0.49-0.83),and specificity of ICE and TEE to diagnosis of left atrial appendage thrombus was 1.0 (95% CI: 0.99-1.00) vs 0.98 (95% CI: 0.96-0.99) . The AUC of ICE and TEE were 0.9846 (SEAUC = 0.0196) and 0.9655 (SEAUC = 0.0401), and the Q * statistics were 0.9462 (SEQ * = 0.0406) and 0.9127 (SEQ * = 0.0616), respectively. Z test was performed on Q * statistics (Z = 0.45, P> 0.05), there was no significant difference between ICE and TEE. Conclusion: ICE and TEE have similar diagnostic efficacy for left atrial appendage thrombosis, but ICE has higher sensitivity and specificity, which has certain advantages over TEE and has clinical application prospects.