Outcomes of Adding Computed Tomography Angiography for Pre-procedural Planning of Left Atrial Appendage Occlusion: a Systematic Review and Meta-analysis.

BACKGROUND

Multi-society expert consensus statements on catheter-based left atrial appendage occlusion (LAAO) suggest transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) for pre-procedural planning. However, evidence comparing the outcomes of adding CCTA to TEE on procedural success is limited.

OBJECTIVE

Perform a systematic review and meta-analysis to determine the impact of adding CCTA to TEE for pre-procedural planning in patients undergoing LAAO.

METHODS

We systematically searched Cochrane, Embase, and Medline for observational studies and randomized controlled trials (RCTs) comparing the addition of CCTA vs. TEE alone. The primary endpoint was procedural success. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.

RESULTS

Systematic review identified four studies for meta-analysis, three RCTs and one observational study, including a total of 824 patients, of whom 496 (60.2%) underwent additional CCTA. In the pooled analysis, procedural success was higher with added CCTA (RR 1.10; 95% CI 1.01-1.19; p = 0.022; I²=52%). A subgroup analysis of only RCTs confirmed these findings with a slightly higher magnitude of effect and lower heterogeneity (RR 1.15; 95% CI: 1.06-1.25; I2 = 0%).