Arrhythmias & electrophysiologyMeta-analysis
Intracardiac vs. transesophageal echocardiography in patients undergoing ablation for atrial fibrillation: a systematic review and meta-analysis
- systematic review and meta-analysis
- inverse-variance (IV) random-effects model
Authors' 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.
Study context
- Population
- Patients undergoing catheter ablation for atrial fibrillation (AF) with or without left atrial appendage closure (LAAC)eight studies, 3903 (50.9%) underwent procedures with intracardiac echocardiography (ICE) guidance
- Participants
- 7,671 patients
- Comparison
- ICE with transesophageal echocardiography (TEE) guidance during AF ablation ± LAAC
- ICEn = 3,903
Pooled result
Cardiac tamponade
Relative risk
0.86
95% CI 0.44–1.66
P = 0.39
ICE vs TEE
RR 0.86 (95% CI 0.44–1.66); P = 0.39
As reported in the abstract
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Stroke, or transient ischaemic attack · no significant difference | 1.00 (0.39–2.55) | P = 0.57 | |
| Vascular complications · no significant difference | 0.80 (0.51–1.25) | P = 0.37 | |
| Pre-procedure LAA thrombus detection · lower with ICE | 0.32 (0.11–0.94) | P = 0.04 | |
| 0.10.31310Relative risk (log scale) |
| Outcome | SMD (95% CI) | P value | |
|---|---|---|---|
| Radiation dose · lower with ICE | −0.47 (−0.90 to −0.04) | P = 0.03 | |
| −1−0.500.5Difference (linear scale) |
| Outcome | MD (min) (95% CI) | P value | |
|---|---|---|---|
| Procedure duration, combined AF ablation + LAAC · significantly lower only in combined AF ablation + LAAC | −19.56 (−24.15 to −14.97) | P < 0.01 | |
| −30−20−10010Difference, min (linear scale) |
| Outcome | Estimate | P value |
|---|---|---|
| Fluoroscopy time · lower with ICE | −4.25 min (95% CI −6.01 to −2.49) | P < 0.01 |
Original publication
Intracardiac vs. transesophageal echocardiography in patients undergoing ablation for atrial fibrillation: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. Published 5 August 2026. doi:10.1093/ehjci/jeag206
Summarised from the published abstract; every number is checked against it