{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:09Z","timestamp":1787013849279,"version":"build-2736575974"},"reference-count":52,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Noninvasive Electrocardiol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the comparative efficacy, safety, and radiation exposure outcomes of intracardiac echocardiography (ICE)\u2010guided versus TEE\/fluoroscopy\u2010guided trans\u2010septal puncture (TSP) in left atrial procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta\u2010analysis of randomized and observational studies comparing ICE\u2010guided with TEE\u2010 or fluoroscopy\u2010only\u2013guided TSP. Eight studies encompassing over 9000 patients undergoing atrial fibrillation (AF) ablation or left atrial appendage occlusion (LAAO) were included. Primary endpoints were fluoroscopy time, radiation dose, first\u2010pass success, puncture time, total procedure time, and major safety outcomes. Random\u2010effects models were used to pool mean differences or hazard ratios with 95% confidence intervals (CIs). Risk of bias was assessed using validated tools, and funnel plots with sensitivity analyses evaluated robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ICE guidance significantly reduced fluoroscopy time (MD \u20132.07\u2009min, 95% CI \u20132.37 to \u22121.77;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and radiation dose (MD \u20132.30, 95% CI \u20133.27 to \u22121.27;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). First\u2010pass success and total procedure time were comparable between groups. Safety endpoints, including tamponade, pericardial effusion, and composite major adverse events, showed no significant increase with ICE. Funnel plots and leave\u2010one\u2010out analyses confirmed the stability of results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ICE\u2010guided TSP reduces radiation exposure without compromising efficacy or safety, supporting its adoption as a valuable imaging modality in left atrial interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anec.70186","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:53:34Z","timestamp":1775721214000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Outcomes of\n                    <scp>ICE<\/scp>\n                    Versus\n                    <scp>TEE<\/scp>\n                    \/Fluoroscopy Guidance Transseptal Puncture in\n                    <scp>LA<\/scp>\n                    Procedures: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"31","author":[{"given":"Asim Mohammed Eldai","family":"Abdalla","sequence":"first","affiliation":[{"name":"Department of Anatomy College of Medicine, King Khalid University  Abha Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kolluru Pavani","family":"Durga","sequence":"additional","affiliation":[{"name":"Shri B M Patil Medical College and Research Center  Vijayapura India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Animisha","family":"Chukka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine NRI Institute of Medical Sciences  Visakhapatnam India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mounika","family":"Kotte","sequence":"additional","affiliation":[{"name":"Prime South GME, Consortium Knapp Medical Center  Weslaco TX 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