Key result
ICE guidance during AF ablation linked to reduced recurrence, mediated by abnormal force-over-time.
Why the study?
Abnormal force-over-time leads to gaps and impacts ablation continuity and transmurality during RFCA for AF, and the impact of ICE on force-over-time and recurrence required investigation.
Does intracardiac echocardiography guidance improve procedural parameters and reduce recurrence in patients undergoing radiofrequency catheter ablation for atrial fibrillation?
Observational (n=167)
Does intracardiac echocardiography guidance improve procedural parameters and reduce recurrence in patients undergoing radiofrequency catheter ablation for atrial fibrillation?
Intracardiac echocardiography guidance during radiofrequency catheter ablation for atrial fibrillation influences the distribution of abnormal force-over-time and may improve recurrence outcomes, likely mediated through these procedural parameters.
Answers are grounded in this paper and cite their sources.
ICE guidance was associated with modestly lower recurrence; hypothesis-generating and requires randomized confirmation before practice change.
Objective Radiofrequency catheter ablation (RFCA) has become a first-line treatment for atrial fibrillation (AF). Abnormal force-over-time (FOT), a procedural parameter, leads to gaps and influences ablation continuity and transmurality. Intracardiac echocardiography (ICE) provides valuable guidance during RFCA. This retrospective study investigates the impact of ICE on FOT and recurrence in RFCA. Methods Propensity score matching (PSM) was performed to mitigate the impact of intergroup imbalance. The Kendall correlation, point-biserial correlation coefficient test and multivariate Gamma regression were employed to analyze factors influencing procedure and ablation time. Univariate and multivariate Cox regression analysis were performed to analyze factors influencing recurrence. Results A total of 167 patients were enrolled. After PSM, 102 patients were included with 51 patients in each of the ICE and non-ICE groups. After adjusting for confounding factors, baseline eGFR (HR = 0.97, 95% CI 0.94–0.99, P = 0.017) and high FOT count in RPS segment (HR = 1.48, 95% CI 1.05–2.09, P = 0.025) were independent factors influencing recurrence. The eGFR (RR = 1.005, 95% CI 1.000–1.009, P = 0.038) and low FOT count in LAI segment (RR = 1.019, 95% CI 1.002–1.036, P = 0.033), high FOT count in RPI segment (RR = 0.948, 95% CI 0.902–0.996, P = 0.036) were factors influencing ablation time, while high FOT count in LF segment (RR = 1.072, 95% CI 1.008–1.139, P = 0.029), cardiomyopathy (RR = 2.181, 95% CI 1.339–3.554, P = 0.002), and LAAO (RR = 1.485, 95% CI 1.249–1.766, P < 0.001) were factors influencing procedure time. Conclusions ICE influences the distribution of abnormal FOT across PV segments. ICE-guided procedures demonstrated improvement in recurrence. However, the benefits may not be directly provided by ICE but rather mediated through the occurrence of abnormal FOT.
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Liu et al. (2026) conducted an observational in atrial fibrillation (n=167). Intracardiac echocardiography (ICE) vs. non-ICE was evaluated on recurrence. Intracardiac echocardiography during radiofrequency catheter ablation for atrial fibrillation improved recurrence, though benefits may be mediated by the occurrence of abnormal force-over-time.
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