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Background <p>Excluding left atrial appendage thrombus via imaging is essential prior to atrial fibrillation (AF) catheter ablation to prevent thromboembolic events. While transesophageal echocardiography (TEE) is considered the reference standard, intracardiac echocardiography (ICE) has emerged as a workflow-optimizing alternative, though its comparative safety and efficacy remain debated. This study aimed to compare ICE and TEE in patients undergoing AF ablation.</p> Methods <p>PubMed, Embase, Cochrane Library, and Web of Science were systematically searched for studies comparing ICE with TEE in AF ablation from inception to October 2025. Data were pooled using a random-effects model. Heterogeneity was evaluated using the I² statistic. All statistical analyses were conducted using R software (version 4.5.1).</p> Results <p>Four studies comprising 4,447 patients were included. The pooled analyses showed no significant differences regarding thrombus presence (RR: 0.763; 95% CI: 0.301–1.929) or risk of stroke (RR: 0.766; 95% CI: 0.276–2.123). notably, ICE significantly shortened fluoroscopy time (MD: -4.94; 95% CI: -5.76 to -4.12). Procedural waiting time (MD: -5.58; 95% CI: -11.69 to 0.54), total procedure time, and radiofrequency delivery time did not differ significantly between groups. Regarding safety, incidences of pericardial effusions and major bleeding events were comparable between the two modalities.</p> Conclusion <p>Our findings suggest that ICE is a safe and effective alternative to TEE for AF ablation, offering comparadiagnostic efficacy and safety profiles while significantly reducing fluoroscopy times. PROSPERO registration: CRD420251234526.</p> Clinical trial registration <p>Not applicable.</p>

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Intracardiac versus transesophageal echocardiography in atrial fibrillation ablation: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月18日

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  • Matheus da Silva Ferreira,
  • Samuel Oliveira de Amorim,
  • Pedro Lívio Gomes Moura,
  • Nathan Fellipe Cardoso da Silva,
  • Felipe Henrique Lima Pereira,
  • Marcos Manoel Honorato,
  • José Alexandre Neto

摘要

Background

Excluding left atrial appendage thrombus via imaging is essential prior to atrial fibrillation (AF) catheter ablation to prevent thromboembolic events. While transesophageal echocardiography (TEE) is considered the reference standard, intracardiac echocardiography (ICE) has emerged as a workflow-optimizing alternative, though its comparative safety and efficacy remain debated. This study aimed to compare ICE and TEE in patients undergoing AF ablation.

Methods

PubMed, Embase, Cochrane Library, and Web of Science were systematically searched for studies comparing ICE with TEE in AF ablation from inception to October 2025. Data were pooled using a random-effects model. Heterogeneity was evaluated using the I² statistic. All statistical analyses were conducted using R software (version 4.5.1).

Results

Four studies comprising 4,447 patients were included. The pooled analyses showed no significant differences regarding thrombus presence (RR: 0.763; 95% CI: 0.301–1.929) or risk of stroke (RR: 0.766; 95% CI: 0.276–2.123). notably, ICE significantly shortened fluoroscopy time (MD: -4.94; 95% CI: -5.76 to -4.12). Procedural waiting time (MD: -5.58; 95% CI: -11.69 to 0.54), total procedure time, and radiofrequency delivery time did not differ significantly between groups. Regarding safety, incidences of pericardial effusions and major bleeding events were comparable between the two modalities.

Conclusion

Our findings suggest that ICE is a safe and effective alternative to TEE for AF ablation, offering comparadiagnostic efficacy and safety profiles while significantly reducing fluoroscopy times. PROSPERO registration: CRD420251234526.

Clinical trial registration

Not applicable.