3C-03 - Reduced complications associated with use of intracardiac echocardiography (ICE) and three-dimensional (3D) mapping during catheter ablation procedure among elderly patients with atrial fibrillation

Background: Atrial fibrillation (AF) affects ~6 million people in the United States (US), and this number is expected to rise with the ageing of the population. Catheter ablation (CA) is a mainstay treatment option for AF. Intracardiac echocardiography (ICE) and advanced three-dimensional (3D) electroanatomical mapping are increasingly becoming an integral component of CA procedure.

Objectives: To examine the difference in procedure-related complications among patients with AF undergoing CA without ICE and 3D electroanatomical mapping use versus those who underwent CA with ICE and 3D mapping use.

Methods: A retrospective cohort of elderly (age ≥65 years) patients with AF who underwent CA procedure between 2017 and 2023 was identified using the Medicare Standard Analytic Files Database. Patients were then categorized into two cohorts: CA with no ICE/3D mapping cohort versus CA with ICE/3D mapping cohort. The primary outcome of interest was incidence of a composite of complications (any) during CA procedure or 30 days post CA period. Secondary outcomes of interest included cardiac perforation and death. Inverse probability of treatment weighting (IPTW) method was used to balance study covariates (including demographics and clinical characteristics) across the two cohorts. Cox regression models were performed for outcomes comparison.

Results: A total of 206,252 patients (35,490 in the no ICE and no 3D mapping cohort and 170,762 in the ICE and 3D mapping cohort) were identified after sample attrition. All covariates were well balanced among the two cohorts after applying IPTW. The 30-day incidence of composite complication was significantly higher for patients who underwent CA without using ICE/3D mapping versus those who had the procedure with ICE/3D mapping use (7.3% vs. 2.2%, log-rank p-test < 0.001).Cox regression model revealed that patients who underwent CA without using ICE/3D mapping were ~3.5 times more likely to have 30-day any complication versus ICE/3D mapping patients (Hazard Ratio [HR] 3.51; 95% Confidence Interval [CI] 3.31-3.72). The incidence of cardiac perforation was significantly higher among patients without ICE/3D mapping versus those in the ICE/3D mapping cohort (2.5% vs. 0.1%, log-rank p-test <0.001; HR 19.84; 95% CI 16.91-23.28). Patients undergoing CA with no ICE/3D mapping use were also ~7.3 time more likely to have 30-day death post CA versus those in the ICE/3D mapping group (1.6% vs. 0.2%, log-rank p-test <0.001; HR 7.27; 95% CI 6.36-8.32).

Conclusion: Absent use of ICE and 3D mapping during CA procedures was associated with significantly higher risk of complications (including cardiac perforation) and death among elderly patients with AF.