The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

Abstract

Aims The optimal use of intracardiac echocardiography (ICE) may reduce fluoroscopy time and procedural complications during endocardial ablation of cardiac arrhythmias. Due to limited evidence in this area, we conducted the first systematic literature review and meta‐analysis to evaluate outcomes associated with the use of ICE. Methods and Results Studies reporting the use of ICE during ablation procedures vs without ICE were searched using PubMed/MEDLINE. A meta‐analysis was performed on the 19 studies (2186 patients) meeting inclusion criteria, collectively representing a broad range of arrhythmia mechanisms. Use of ICE was associated with significant reductions in fluoroscopy time (Hedges' g −1.06; 95% confidence interval [CI] −1.81 to −0.32; P < .01), fluoroscopy dose (Hedges' g −1.27; 95% CI −1.91 to −0.62; P < .01), and procedure time (Hedges' g −0.35; 95% CI −0.64 to −0.05; P = .02) vs ablation without ICE. A 6.95 minute reduction in fluoroscopy time and a 15.2 minute reduction in procedure time was observed between the ICE vs non‐ICE groups. These efficiency gains were not associated with any decreased effectiveness or safety. Sensitivity analyses limiting studies to an atrial fibrillation (AF) only population yielded similar results to the main analysis. Conclusion The use of ICE in the ablation of cardiac arrhythmias is associated with significantly lower fluoroscopy time, fluoroscopy dose, and shorter procedure time vs ablation without ICE. These efficiency improvements did not compromise the clinical effectiveness or safety of the procedure.

Zero‐fluoroscopy catheter ablation of premature ventricular contractions at left coronary cusp near left main coronary artery

“…The ability to produce 3D maps by using ICE merged with EAM permits thorough examination of the anatomical structures of the heart while avoiding coronary angiography and limiting risk. 11 The coronary angiography presents risks, including allergic reaction or renal injury from contrast use, vascular injury from a second arterial access, additional radiation exposure, and rarely, air embolus or coronary dissection as reported in previous studies. 5 Thus, the combination of EAM and ICE provided a more versatile and precise tool compared to the flat two-dimensional fluoroscopic views.…”

“…Usually, the coronary angiography is recommended before and during CA to make sure there is a safe distance from the coronary ostia. The ability to produce 3D maps by using ICE merged with EAM permits thorough examination of the anatomical structures of the heart while avoiding coronary angiography and limiting risk 11 . The coronary angiography presents risks, including allergic reaction or renal injury from contrast use, vascular injury from a second arterial access, additional radiation exposure, and rarely, air embolus or coronary dissection as reported in previous studies 5 .…”

“…Furthermore, radiation exposure is associated with acute and subacute skin injury, malignancies, cataracts, thyroid dysfunction, and other diseases. 11 Because of these potential risks and the linear relationship between radiation dose and increased risk of future malignancy (ie, no dose of radiation is considered safe), the underlying principle of radiation exposure states that the radiation dose must be "as low as reasonably achievable" (ALARA). 12,13 The patient of this case underwent RF ablation of PVCs without coronary angiography using a zero-fluoroscopy approach.…”

“…ICE is also helpful in confirming adequate tissue apposition of the ablating catheter, monitoring the pericardium, as well as promptly recognizing iatrogenic pericardial effusion. Furthermore, radiation exposure is associated with acute and subacute skin injury, malignancies, cataracts, thyroid dysfunction, and other diseases 11 . Because of these potential risks and the linear relationship between radiation dose and increased risk of future malignancy (ie, no dose of radiation is considered safe), the underlying principle of radiation exposure states that the radiation dose must be "as low as reasonably achievable" (ALARA) 12,13 .…”

Intracardiac echocardiography-guided transseptal puncture for flouroless catheter ablation of left-sided tachycardias

“…Although fluoroscopic guidance to perform TSP is still the gold standard in clinical practice (2,3), ultrasoundbased techniques including transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) have been adopted to provide additional imaging of different anatomical structures relevant to TSP. Utilization of both imaging techniques could shorten fluoroscopy exposure, increase safety and success rate of electrophysiological procedures, especially in challenging cases (4)(5)(6). Furthermore, improvement of image quality and integration with three-dimensional 3D electro-anatomic mapping (EAM) systems enabled ICE to become an invaluable tool for safe and effective guidance of catheters and needle direction during TSP without the use of fluoroscopy (7).…”