The use of intracardiac echocardiography in catheter ablation of supraventricular tachycardia: a systematic review and meta-analysis

Background Intracardiac echocardiography (ICE) enables real-time visualization during catheter ablation and may help reduce fluoroscopy exposure and procedural complications. However, evidence comparing ICE-guided and conventional fluoroscopy-guided ablation of supraventricular tachycardias (SVTs) remains limited. Objective To compare the safety and efficacy of ICE-guided versus fluoroscopy-guided SVT ablation in a systematic review and meta-analysis. Methods Electronic databases were systematically searched for studies comparing ICE-guided and fluoroscopy-guided SVT ablation. The analyzed outcomes included total procedure time, ablation time, fluoroscopy time, complication rate, and acute procedural success. Random- effects models were used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Results Five studies comprising 682 patients were included, involving cavotricuspid isthmus ablation for typical atrial flutter and slow pathway ablation for AVNRT. Compared with the fluoroscopy-guided technique, ICE guidance significantly reduced total fluoroscopy time (RR = –6.36 min; 95% CI –12.00 to –0.71; p ≤ 0.01) and total ablation time (RR = –88.15 s; 95% CI –145.91 to –30.39; p ≤; 0.01). No significant differences were observed in total procedure time (RR = –13.14 min; 95% CI –29.46 to 3.18; p = 0.11), acute success (RR = 1.00; 95% CI 0.99–1.01; p = 0.66), or complication rates (RR = 1.34; 95% CI 0.30–5.93; p = 0.69). Conclusions ICE-guided ablation of supraventricular tachycardias is associated with significantly shorter fluoroscopy and ablation times, while maintaining comparable safety, total procedure duration, and acute success rates compared with conventional fluoroscopy-guided ablation.