Intracardiac noninferior to transesophageal echo for preventing thromboembolic complications

For patients undergoing atrial fibrillation (AF) ablation, intracardiac echocardiography (ICE) is as good as transesophageal echocardiography (TEE) in terms of reducing the risk of thromboembolic complications, according to a study.

The study included 1,810 AF patients (mean age 64.3 years, 48 percent female, 49 percent had paroxysmal AF) who were scheduled for catheter ablation. These patients were randomly assigned to undergo thrombus screening with either ICE (n=906) or TEE (n=904) prior to ablation.

The incidence of periprocedural thromboembolic events (stroke, transient ischemic attack, or systemic embolism) was the primary endpoint. Secondary endpoints included thrombus detection, procedural safety and efficiency, and patient-reported comfort.

Thromboembolic events occurred in 0.4 percent of patients in the ICE group and in 0.6 percent of those in the TEE group (risk difference, −0.11 percent, 95 percent confidence interval [CI], −0.84 to 0.62; p=0.01 for noninferiority). The percentage of thrombus detected was 2 percent with ICE vs 1.5 percent with TEE (relative risk [RR], 1.29, 95 percent CI, 0.64–2.61; p=0.48), with more nonleft atrial appendage thrombi in ICE (0.6 percent vs 0 percent; p<0.001).

Major bleeding related to transseptal puncture occurred less frequently in the ICE vs the TEE group (0.2 percent vs 1.2 percent; RR, 0.18, 95 percent CI, 0.04–0.81; p=0.03). Compared with TEE, ICE was associated with shorter mean fluoroscopy time (4.2 vs 9.3 min; p<0.001), shorter preprocedural waiting time (14.4 vs 23.6 h; p<0.001), and lower anxiety or depression prevalence (24.6 percent vs 37.5 percent; RR, 0.66, 95 percent CI, 0.56–0.76; p<0.001).