How effective is intracardiac echocardiography in reducing cardiac tamponades

Atrial fibrillation (AF) is the most prevailing tachyarrhythmia. AF ablation is the most effective treatment to help relieve symptoms. However, AF ablation entails a risk of complications, such as cardiac tamponade which can be life-threatening. Intra-cardiac echocardiography (ICE) allows for a direct visualization of the transseptal puncture but can also be useful for early detection of periprocedural complications and reduction of X-ray exposure.

To evaluate the efficacy of ICE in reducing cardiac tamponades after AF-ablation procedures at our center. Additionally, to examine the impact of ICE on the duration of the procedures and the radiation dose.

A retrospective registry-based study included all patients who underwent AF-ablation procedures between Sep 2015 and Sep 2023. They were then divided into two groups based on ICE usage during the procedures.

A total of 1772 patients with AF underwent the procedure, 884 were ablated with ICE and 888 with the standard method. Postprocedural cardiac tamponades occurred in 15 cases (0.8%), 6 cases (0.7%) in the ICE group and 9 cases (1.0%) in the non-ICE group, the difference was not statistically significant (p=0.452). The patients in the ICE group were exposed to higher mean radiation doses (825cGym2 vs 725cGym2) and had longer procedures (158mins vs. 111 minutes) . The ICE group had significantly more comorbidities like hypertension, ischemic heart disease, previous open heart surgery, heart failure and persistant AF.

Utilization of ICE was not associated with a significantly lower incidence of tamponades. Contrary to previous studies, ICE-assisted procedures were on average longer with higher radiation. A trend was seen towards lower tamponades and possibly this difference would be statistically significant in a larger study population. ICE has been shown in many studies to be a beneficial tool in both safety and efficacy aspects. However, due to the cost it is only used in our center when difficulties arise during a procedure which can explain longer procedure time and radiation in these instances. As the ICE group also had more comorbidities and advanced AF type, this can possibly lead to a higher tamponade risk and therefore skew our results.