OBJECTIVES: To investigate clinical values of intracardiac echocardiography (ICE) in guiding radio-frequency catheter ablation (RFCA) for atrial fibrillation (AF) and factors driving the use of ICE in a real-world setting.

METHODS: This retrospective cohort study enrolled AF patients undergoing ICE- or traditional fluoroscopy (TF)-guided RFCA for AF in a tertiary hospital. Patient characteristics, procedure-related outcomes, radiation exposure, and ablation efficacy were extracted from medical records associated with RFCA. Multiple logistic regression model was used to explore the impact of patient characteristics on the use of ICE in the enrolled patients. To control the confounding effects arising from different ablation approaches, patients only undergoing pulmonary vein isolation (PVI) were included to create propensity score matched pairs for the comparisons between ICE and TF.

RESULTS: 76 patients in the enrolled 227 patients (33.5%) underwent ICE-guided RFCA. Patients with atrial tachycardia [odds ratio (OR) 3.692, p=0.062], a higher Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly score (OR 1.541, p=0.050), or heart failure (OR 2.098, p=0.156) were associated with a higher chance of using ICE. 47 propensity score matched pairs were created from 156 patients only undergoing PVI. Patients using ICE exhibited a significantly higher success rate in the first transseptal puncture (100% vs. 87.2%, p=0.041) and less radiation exposure [utilization of radiographic contrast agent (2.7 ml vs. 6.0 ml, p<0.001), fluoroscopy time (5.7 mins vs. 7.6 mins, p=0.026), and fluoroscopy dose (208.4 mGy vs. 332.3 mGy, p=0.024)] than patients using TF. Other efficacy outcomes (PVI success, free from AF after RFCA and complications) showed no difference between the matched pairs.

CONCLUSIONS: A trend without statistical significance was observed for increasing use of ICE in patients with more complicated AF. ICE-guided RFCA for AF contributed to an increased success rate in transseptal puncture and radiation exposure reduction.