Key result
Intracardiac echocardiography shows no difference in cardiac tamponade risk compared to TEE during AF ablation.
Why the study?
Intracardiac echocardiography is a real-time imaging tool performed without general anesthesia, but its safety compared to transesophageal echocardiography remains unclear.
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?
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?
Relative Risk: 0.86 (95% CI 0.44–1.66)
p-value: p=0.39
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.
ICE non-inferior and safe versus TEE for AF ablation ± LAAC; extends evidence supporting anesthesia-free guidance in electrophysiology.
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.
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Dandamudi et al. (2026) 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).