Differences in outcomes among patients with atrial fibrillation undergoing catheter ablation with versus without intracardiac echocardiography

Abstract

Background: Intracardiac echocardiography (ICE) use can lead to early detection of periprocedural complications and may improve patient outcomes by providing real-time visualization of catheter location and the treatment area during cardiac ablation (CA) for atrial fibrillation (AF).

Objective: Examine complications and 12-month healthcare use among patients with AF undergoing CA with versus without ICE use during the procedure in a real-world setting.

Methods: The 2015-2020 IBM MarketScan® Database was used to identify non-elderly adults (age 18-64 years) undergoing CA for AF. Patients were classified into ICE/non-ICE groups based on the presence or absence of ICE procedure codes. Patients in each group were matched on study covariates using propensity scores. Peri-procedural complications, 12-month cardiovascular (CV) or AF-related inpatient admission, repeat CA, and cardioversion were compared using a Cox proportional hazard model.

Results: 1371 patients were identified in each study cohort (ICE and non-ICE) after propensity matching. Patients who had CA with ICE had a significantly lower rate of complications than those without (2.9% vs. 5.8%; p < .001). The risk of complications was 50% lower with ICE use (hazard ratio [HR] 0.50; 95% confidence interval [CI] 0.34-0.72). For assessment of 12-month healthcare utilization, 1250 patients were identified in each cohort after propensity matching. ICE use was associated with a 36% lower risk of 12-month repeat ablation (HR 0.64; 95% CI 0.49-0.83). No differences in CV- or AF-related inpatient admission and cardioversion were observed.

Conclusion: Among patients with AF, the use of ICE during an ablation procedure was associated with lower incidence of complications and repeat ablation.

Keywords: acute ischemic stroke; atrial fibrillation; catheter ablation; intracardiac echocardiography.