Abstract 18727: Outcomes of Utilization of Transesophageal Echocardiogram (TEE) vs Intracardiac Echocardiogram (ICE) for Atrial Fibrillation Ablations in the Real-AF Registry

Abstract

Introduction: Transesophageal (TEE) and intracardiac (ICE) echocardiogram are widely used strategies to rule out LAA thrombus prior to atrial fibrillation (AF) ablation. We compare the utilization of TEE and ICE, outcomes and complications of each strategy. Methods: The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (PAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that is enrolling patients undergoing AF ablation at high-volume centers. We compared complications rates (Table 1) between TEE and ICE in patients with AF underdoing index ablation for AF in the REAL-AF registry. Patients who underwent both TEE and ICE were excluded from the analysis. Bleeding complication was defined as bleeding that occurs within the first 72 hours of the procedure requiring transfusion or resulting in >20% drop in hemoglobin. Vascular access complications included AV fistula or pseudo-aneurysm needing intervention. Results: A total of 1628 patients were included in the analysis.The mean age was 64.78 (SD=11.43) years, 45.7% were women, mean BMI was 30.36 (SD=6.71) and mean CHAD2DS2VASc score was 2.49 (SD=1.51). TEE was used in 911 patients (58.5%) and ICE was used in 717 (46.1%) ] prior to ablation. There were 0% strokes reported in the TEE group vs 0.1% in the ICE group (p = 0.095). Among other complications reported there was no statistical difference between the two groups (Table 1). There was no significant difference between the two groups on recurrence of arrhythmias at 12 months (HR: = 0.983, CI: 0.79,1.3 , p < 0.894) Conclusion: Both TEE and ICE are acceptable strategies for pre-ablation assessment of left atrium and LAA. There are no significant differences in stroke rates between the two groups. Other reported complications are also similar between the two groups. Choice of either TEE vs ICE depend on patient specific characteristics, hospital resources and operator preference.