Intracardiac versus Transesophageal Echocardiography in patients undergoing Ablation for Atrial fibrillation: A systematic review and meta-analysis
- Journal
- European heart journal. Cardiovascular Imaging (Q1)
- Published
- 5 August 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Mrunalini Dandamudi, Bezalel Hakkeem, Juan Pinilla, Nathalia Schettino Samad, Larissa Araújo de Lucena, Zainab Humayun, et al.
- PMID
- 42554588
- DOI
- 10.1093/ehjci/jeag206
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 6 August 2026).
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 6 August 2026): ICE vs TEE meta‑analysis for AF ablation
Abstract
BACKGROUND: Intracardiac echocardiography (ICE) is a valuable, real-time imaging tool in structural cardiology and electrophysiology, performed without general anesthesia. However, its safety compared to transesophageal echocardiography (TEE) remains unclear. OBJECTIVE: To conduct a meta-analysis evaluating outcomes of catheter ablation for atrial fibrillation (AF) with or without left atrial appendage closure (LAAC) guided by TEE versus ICE. METHODS: Databases were searched for studies comparing ICE with TEE guidance during AF ablation ± LAAC. Outcomes were pooled using the Inverse-Variance (IV) random-effects model in R, with risk ratios (RRs) for dichotomous variables and mean or standardized mean differences (MD or SMD) for continuous variables, and 95% confidence intervals (CIs) reported. RESULTS: We included 8 studies involving 7,671 patients, of whom 3,903 (50.9%) underwent procedures with ICE guidance. There were no significant differences between groups in cardiac tamponade risk (RR 0.86; 95% CI 0.44-1.66; p = 0.39), stroke or TIA (RR 1.00; 95% CI 0.39-2.55; p = 0.57), vascular complications (RR 0.80; 95% CI 0.51-1.25; p = 0.37). ICE was associated with lower pre-procedure LAA thrombus detection (RR 0.32; 95% CI 0.11-0.94; p = 0.04), radiation dose (SMD -0.47; 95% CI -0.90 to -0.04; p = 0.03), and fluoroscopy time (-4.25 mins; 95% CI -6.01 to -2.49; p < 0.01) but the procedure duration was significantly lower only in combined AF ablation + LAAC (MD -19.56 mins; 95% CI -24.15 to -14.97; p < 0.01). CONCLUSION: This meta-analysis indicates that ICE is a safe, effective, and non-inferior alternative to TEE for patients undergoing AF ablation ± LAAC. However, TEE remains an effective tool for detecting LAA thrombus.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.