3D Transesophageal Echocardiography in the Selection of Occluder Size for Left Atrial Appendage Occlusion: A Meta-Analysis

Background: Left atrial appendage occlusion (LAAO) can effectively reduce the risk of stroke in atrial fibrillation (AF) patients. However, the structure of left atrial appendage (LAA) varies greatly among individuals, and the size of the occluder influences the surgical success rate and prognosis. This study used a meta-analysis to investigate whether three dimensional-transesophageal echocardiography (3D-TEE) can prompt physicians to select the appropriate size of the occluder, thereby improving prognosis in patients with LAAO. Methods: Studies on 3D-TEE-assisted selection of occluder sizes in the treatment of LAAO were searched in pubmed, cochrane, Web of Science, CNKI, Wanfang, and Weipu public databases from the inception of each database to June 10, 2024. The QUADAS-2 tool was used to assess the quality of the studies. Results: 10 studies published between 2016 and 2024 were finally included, with a total sample size of 552 cases. The maximum opening of the LAA obtained by 3D-TEE, coronary angiography (CAG) and video-assisted thoracic surgery (VATS) significantly correlated with the size of the occluder (p < 0.05). 3D-TEE was superior to 2D-TEE in measuring the maximum (p = 0.04) and minimum diameters (p = 0.01) of LAA openings, and to DSA in measuring depth (p = 0.01). Conclusion: 3D-TEE can be applied to obtain LAA opening data close to the size of the occluder with minimal side effects and to assist physicians in selecting the appropriate occluder.