Intracardiac vs. transesophageal echocardiography in patients undergoing ablation for atrial fibrillation: a systematic review and meta-analysis.
Mrunalini Dandamudi, Bezalel Hakkeem, Juan Pinilla et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the safety and efficacy of intracardiac echocardiography (ICE) versus transesophageal echocardiography (TEE) in 7671 patients undergoing catheter ablation for atrial fibrillation (AF) with or without left atrial appendage closure (LAAC). The study found no significant differences in major complications, but ICE was associated with lower LAA thrombus detection, reduced radiation dose, and shorter fluoroscopy time.
Key findings
- ICE showed no significant difference in cardiac tamponade risk compared to TEE (RR 0.86; 95% CI 0.44-1.66; P = 0.39).
- ICE was associated with lower pre-procedure LAA thrombus detection (RR 0.32; 95% CI 0.11-0.94; P = 0.04).
- ICE resulted in a reduced radiation dose (SMD -0.47; 95% CI -0.90 to -0.04; P = 0.03) and shorter fluoroscopy time (-4.25 min; 95% CI -6.01 to -2.49; P < 0.01).
- Procedure duration was significantly lower in combined AF ablation + LAAC with ICE (MD -19.56 min; 95% CI -24.15 to -14.97; P < 0.01).
Why it matters
Understanding the comparative safety and efficacy of ICE and TEE in AF ablation can guide clinicians in selecting imaging modalities that optimize patient outcomes while minimizing risks and procedural times.