Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta-analysis of observational and randomized studies

Introduction Intracardiac echocardiography (ICE) provides superior quality images and can monitor catheter location within the heart continuously. Given the limited evidence, we conducted the meta-analysis to evaluate outcomes with ICE in radiofrequency (RF) ablation of atrial fibrillation (AF). Methods and Results PubMed/MEDLINE, Embase, and Cochrane were searched for studies reporting RF ablation for treatment of AF with the use of ICE versus without ICE and 12 studies were included. Sensitivity analyses limiting studies to ablation with the use of contact force (CF) catheters were conducted and subgroup analyses were performed according to the published year. In main analyses, RF ablation with ICE for treatment of AF was associated with significant reduction in total X-ray time (mean difference [MD], -9.80; 95% confidence interval [CI], -15.57 to -4.04; I-2 = 99%; p < .01), total procedure time (MD, -17.65; 95% CI, -30.22 to -5.09; I-2 = 89%; p < .01), and complications (relative risk [RR], 0.90; 95% CI, 0.87-0.92; I-2 = 20%; p < .01) versus without ICE. The ICE-guided group tended to decrease total absorbed X-ray dose (standardized mean difference, -0.91; 95% CI, -1.86 to 0.04; I-2 = 96%; p = .06). Freedom from arrhythmia (RR, 1.06; 95% CI, 0.98-1.14; I-2 = 0%; p = .13) was comparable between the two groups. Conclusion In patients with AF, ICE-guided RF ablation is correlated with significant reductions in total X-ray time, total procedure time, and complications versus ablation without ICE. Total absorbed X-ray dose tends to reduce in the ICE group and freedom from arrhythmia is comparable between the two groups.