Intracardiac vs Transesophageal Echocardiography in Atrial Fibrillation Ablation

作者：Xiaofeng Hu, Weifeng Jiang, Xinhua Wang, Ping Ye, Xiangting Li, Ying Wang, Qidong Zheng, Yanzhe Wang, Lihua Leng, Zengtang Zhang, Bing Han, Yu Zhang, Mu Qin, Xu Liu, Xumin Hou, ICE vs TEE Study Investigators, Li Zhou, Yang Liu, Shaohui Wu, Kai Xu, Kaige Li, Ziliang Song, Lingcong Kong, Jiamin Niu, Weidong Qi, He Meng, Xuan Jin, Anjing Ji, Wenjuan Cai, Yali Gu, Xiaowu HE · 发表于：JAMA Cardiology · 年份：2025 · DOI：10.1001/jamacardio.2025.3687 · 被引用次数：13 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiac Arrhythmias and Treatments、Cardiovascular Disease and Adiposity

Importance: Transesophageal echocardiography (TEE) is the standard imaging modality for thrombus screening prior to atrial fibrillation (AF) ablation but carries procedural risks. Intracardiac echocardiography (ICE) is an alternative that may offer comparable safety with procedural advantages. Objective: To determine whether ICE is noninferior to TEE in preventing periprocedural thromboembolic events in AF ablation. Design, Setting, and Participants: This multicenter randomized clinical trial was conducted at 10 hospitals in China from August 2022 to July 2023, with a 30-day follow-up, enrolling adults with AF scheduled for catheter ablation who met predefined eligibility criteria. Data analysis was performed from August 2023 to December 2023. Interventions: Thrombus screening with ICE or TEE prior to ablation. Main Outcomes and Measures: The primary end point was the incidence of periprocedural thromboembolic events (stroke, transient ischemic attack, or systemic embolism). Secondary end points included thrombus detection, procedural safety and efficiency, and patient-reported comfort. Results: A total of 1810 patients (mean [SD] age, 64.3 [9.4] years; 868 women [48.0%]; 887 patients [49.0%] with paroxysmal AF) were randomized to ICE (n = 906) or TEE (n = 904). Thromboembolic events occurred in 4 of 906 patients undergoing ICE (0.4%) and 5 of 904 patients undergoing TEE (0.6%) (risk difference, -0.11%; Farrington-Manning 95% CI, -0.84% to 0.62%; P for noninferiority = .01). ...