ICE Noninferior to transesophageal echocardiography for preventing thromboembolic complications in AF Ablation: Study
A new clinical trial published in the Journal of the American Medical Association found that intracardiac echocardiography (ICE) matched transesophageal echocardiography (TEE) in preventing thromboembolic complications and provided added benefits in safety, efficiency, and patient comfort prior to atrial fibrillation (AF) ablation.
TEE provides high-quality cardiac imaging but requires sedation and carries risks like esophageal injury. ICE, by contrast, uses a catheter-based ultrasound probe inserted via a peripheral vein, allowing real-time intracardiac imaging without the need for general anesthesia.
The randomized clinical trial enrolled a total of 1,810 adults with AF scheduled for catheter ablation across 10 hospitals in China between August 2022 and July 2023. The participants were randomly assigned to undergo either ICE (906 patients) or TEE (904 patients) for thrombus screening before ablation. Follow-up continued for 30 days post-procedure.
The average patient age was 64.3 years, with nearly half (48%) being women. About 49% of participants had paroxysmal AF, which is a form characterized by intermittent episodes. The primary endpoint of the study was assessed by the rate of periprocedural thromboembolic events like stroke, transient ischemic attack (TIA), or systemic embolism, showed virtually identical outcomes between the 2 groups.
Thromboembolic complications occurred in 0.4% of ICE patients and 0.6% of TEE patients, which demonstrated noninferiority of ICE with statistical significance (P for noninferiority = .01). Thrombus detection rates found 2.0% in the ICE group versus 1.5% in the TEE group, where this difference that was not statistically significant. However, ICE identified slightly more thrombi outside the left atrial appendage (0.6% vs. none detected with TEE), highlighting its ability to visualize a broader range of cardiac regions.
Major bleeding associated with transseptal puncture occurred less frequently in the ICE group (0.2%) when compared with TEE (1.2%), a statistically significant reduction. Also, ICE users benefited from significantly shorter fluoroscopy exposure (average 4.2 vs. 9.3 minutes), reduced preprocedural waiting time (14.4 vs. 23.6 hours), and a lower prevalence of anxiety or depression before ablation (24.6% vs. 37.5%). Overall, these findings indicate that ICE not only matches TEE in preventing thromboembolic complications but also enhances procedural efficiency and patient well-being.
Source:
Hu, X., Jiang, W., Wang, X., Ye, P., Li, X., Wang, Y., Zheng, Q., Wang, Y., Leng, L., Zhang, Z., Han, B., Zhang, Y., Qin, M., Liu, X., Hou, X., & ICE vs TEE Study Investigators. (2025). Intracardiac vs transesophageal echocardiography in atrial fibrillation ablation: A randomized clinical trial: A randomized clinical trial. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2025.3687
