Real-world evaluation of intracardiac echocardiography guided radio-frequency catheter ablation for atrial fibrillation: a retrospective cohort study

Intracardiac echocardiography (ICE) has been used to guide radio-frequency catheter ablation (RFCA) for better catheter navigation and less radiation exposure in treating atrial fibrillation (AF). This retrospective cohort study enrolled 227 AF patients undergoing ICE- or traditional fluoroscopy (TF)-guided RFCA for AF in a tertiary hospital. ICE was used more often in patients with atrial tachycardia [odds ratio (OR) 3.692, p = 0.062], a higher score of Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly (OR 1.541, p = 0.050), or heart failure (OR 2.098, p = 0.156). Based on the comparisons of 47 propensity score-matched pairs from 156 patients only undergoing pulmonary vein isolation (PVI), patients using ICE exhibited a significantly higher success rate in the first transseptal puncture (100% vs. 87.2%, p = 0.041) and less radiation exposure [utilization of radiographic contrast agent (2.7 ml vs. 6.0 ml, p < 0.001), fluoroscopy time (5.7 min vs. 7.6 min, p = 0.026), and fluoroscopy dose (208.4 mGy vs. 332.3 mGy, p = 0.024)] than patients using TF. Other perioperative efficacy outcomes (PVI success, free from AF after RFCA and complications) showed no difference between the matched pairs. ICE can enhance procedural safety and efficiency of RFCA, particularly for more complex patient profiles, in real-world setting.