Beyond ice: rethinking intraprocedural imaging in atrial fibrillation ablation

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Atrial fibrillation (n=128). Intervention: Real-time three-dimensional transesophageal echocardiography (3D TEE). Primary outcome: Acute procedural success.

Henry Zheng; S Sundaram

doi:10.1007/s10840-026-02381-z

June 19, 2026Journal of Interventional Cardiac Electrophysiology

Beyond ice: rethinking intraprocedural imaging in atrial fibrillation ablation

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Key result

Real-time 3D TEE successfully guided 128 consecutive atrial fibrillation ablation procedures, achieving 100% acute procedural success without major acute complications.

Why the study?

Does real-time 3D TEE provide safe and effective intraprocedural imaging during atrial fibrillation ablation compared to traditional ICE?

Key Points

Evaluate the clinical feasibility, safety, and procedural efficiency of real-time 3D transesophageal echocardiography as a replacement for intracardiac echocardiography during atrial fibrillation ablation.
Single-center retrospective evaluation of N=128 consecutive atrial fibrillation ablation procedures.
Used real-time three-dimensional transesophageal echocardiography for transseptal access, catheter guidance, pulmonary vein engagement, and complication monitoring under physician supervision.
Acute procedural success was achieved in all cases without major acute complications across initial procedures, redo ablations, and concomitant left atrial appendage occlusions.
Median total procedure time was 40 min with an initial median fluoroscopy time of 8.6 min.
Same-day discharge was achieved in 87.5% of patients.

Structured PICO

Does real-time 3D TEE provide safe and effective intraprocedural imaging during atrial fibrillation ablation compared to traditional ICE?

P

Population

128 consecutive patients undergoing atrial fibrillation ablation using real-time 3D TEE as the primary intraprocedural imaging modality.

I

Intervention

Real-time three-dimensional transesophageal echocardiography (3D TEE) as the primary intraprocedural imaging modality

C

Comparator

None (no intracardiac echocardiography [ICE] comparator)

O

Outcome

Acute procedural success and safetysafety

Limitations

Single-center, retrospective study design of the discussed research
No intracardiac echocardiography (ICE) comparator arm
Reports acute rather than long-term outcomes
Single-center
Retrospective study
No ICE comparator
Acute rather than long-term outcomes

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Implication

Real-time 3D TEE represents a feasible, safe, and cost-effective alternative to ICE for intraprocedural imaging during AF ablation, offering significant economic advantages for ambulatory surgical centers.

Abstract

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Discussion

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Cite This Study

Zheng et al. (2026) conducted an editorial in Atrial fibrillation (n=128). Real-time three-dimensional transesophageal echocardiography (3D TEE) was evaluated on Acute procedural success. Real-time 3D TEE successfully guided 128 consecutive atrial fibrillation ablation procedures, achieving 100% acute procedural success without major acute complications.

synapsesocial.com/papers/6a3599c5dd3be7785e70ee13 https://doi.org/10.1007/s10840-026-02381-z

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Beyond ice: rethinking intraprocedural imaging in atrial fibrillation ablation

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Beyond ice: rethinking intraprocedural imaging in atrial fibrillation ablation

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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