Intracardiac echocardiography during AF ablation ± LAAC showed no significant difference in cardiac tamponade risk compared to TEE (RR 0.86; 95% CI 0.44-1.66; p=0.39).
Meta-Analysis (n=7,671)
Does intracardiac echocardiography (ICE) guidance improve safety and procedural outcomes compared to transesophageal echocardiography (TEE) in patients undergoing catheter ablation for atrial fibrillation with or without LAAC?
ICE is a safe and effective alternative to TEE for guiding AF ablation with or without LAAC, offering reduced radiation and fluoroscopy time, though TEE remains superior for detecting LAA thrombus.
Relative Risk: 0.86 (95% CI 0.44–1.66)
p-value: p=0.39
BACKGROUND: Intracardiac echocardiography (ICE) is a valuable, real-time imaging tool in structural cardiology and electrophysiology, performed without general anesthesia. However, its safety compared to transesophageal echocardiography (TEE) remains unclear. OBJECTIVE: To conduct a meta-analysis evaluating outcomes of catheter ablation for atrial fibrillation (AF) with or without left atrial appendage closure (LAAC) guided by TEE versus ICE. METHODS: Databases were searched for studies comparing ICE with TEE guidance during AF ablation ± LAAC. Outcomes were pooled using the Inverse-Variance (IV) random-effects model in R, with risk ratios (RRs) for dichotomous variables and mean or standardized mean differences (MD or SMD) for continuous variables, and 95% confidence intervals (CIs) reported. RESULTS: We included 8 studies involving 7,671 patients, of whom 3,903 (50.9%) underwent procedures with ICE guidance. There were no significant differences between groups in cardiac tamponade risk (RR 0.86; 95% CI 0.44-1.66; p = 0.39), stroke or TIA (RR 1.00; 95% CI 0.39-2.55; p = 0.57), vascular complications (RR 0.80; 95% CI 0.51-1.25; p = 0.37). ICE was associated with lower pre-procedure LAA thrombus detection (RR 0.32; 95% CI 0.11-0.94; p = 0.04), radiation dose (SMD -0.47; 95% CI -0.90 to -0.04; p = 0.03), and fluoroscopy time (-4.25 mins; 95% CI -6.01 to -2.49; p < 0.01) but the procedure duration was significantly lower only in combined AF ablation + LAAC (MD -19.56 mins; 95% CI -24.15 to -14.97; p < 0.01). CONCLUSION: This meta-analysis indicates that ICE is a safe, effective, and non-inferior alternative to TEE for patients undergoing AF ablation ± LAAC. However, TEE remains an effective tool for detecting LAA thrombus.
Dandamudi et al. (Tue,) conducted a meta-analysis in Atrial fibrillation (n=7,671). Intracardiac echocardiography (ICE) vs. Transesophageal echocardiography (TEE) was evaluated on cardiac tamponade risk (RR 0.86, 95% CI 0.44-1.66, p=0.39). Intracardiac echocardiography during AF ablation ± LAAC showed no significant difference in cardiac tamponade risk compared to TEE (RR 0.86; 95% CI 0.44-1.66; p=0.39).
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