Department of Medicine, Mount Sinai St. Luke's and Mount Sinai West, New York, NY, USA.
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
J Interv Card Electrophysiol. 2021 Sep;61(3):461-468. doi: 10.1007/s10840-020-00844-5. Epub 2020 Aug 2.
Intracardiac echocardiography (ICE) use during catheter ablation of atrial fibrillation (AF) provides real-time information to guide transseptal access, for monitoring the ablation and recognition of pericardial bleed. We describe trends of ICE use, impact on complications, and its in-hospital outcomes.
The national in-patient sample database was queried from 2001 to 2014 for diagnosis of AF based on ICD-9-CM 427.31 with a catheter ablation procedure code (37.34) in the same hospitalization and its associated complications. ICE was identified using ICD-9-CM procedure code (37.28). Statistical Analysis System (SAS) was used for analysis.
There was an estimated total 299,152 patients who underwent AF ablation from 2001 to 2014 of which ICE was used in 46,688 (15.6%) patients. The use of ICE significantly increased from 0.08% in 2001 to 15.7% in 2014. In-hospital mortality was significantly lower in patients in whom ICE was used (0.11% vs 0.54%, p < 0.0001). Complications were 52% lower in procedures using ICE vs without ICE (HR [95%CI]; 0.48 [0.44-0.51]). The rate of cardiac complications was also lower in ICE users (3.67% vs 4.51%; p = 0.025). The use of ICE during AF ablation resulted in significantly higher cost of hospitalization ($98,436 ± 597 vs $81,300 ± 310; p < 0.0001), but this was offset by a decreased length of hospital stay (2.1 ± 0.02 vs 4 ± 0.02 days; p < 0.0001).
The use of ICE during AF ablation has increased over the years and is associated with lower in-hospital mortality and procedural complications, shorter LOS but an increased cost of hospitalization.
在心房颤动（AF）的导管消融过程中使用心内超声（ICE）可提供实时信息，以指导经间隔穿刺、监测消融过程并识别心包积血。我们描述了 ICE 使用的趋势、对并发症的影响及其院内结果。
从 2001 年至 2014 年，根据 ICD-9-CM 427.31 中基于诊断的 AF （ICD-9-CM 427.31）和同一住院期间的导管消融程序代码（37.34），从全国住院患者样本数据库中查询诊断为 AF 的患者。使用 ICD-9-CM 程序代码（37.28）来识别 ICE。使用统计分析系统（SAS）进行分析。
在 2001 年至 2014 年期间，估计有 299152 例患者接受了 AF 消融治疗，其中 46688 例（15.6%）患者使用了 ICE。使用 ICE 的比例从 2001 年的 0.08%显著增加到 2014 年的 15.7%。在使用 ICE 的患者中，院内死亡率显著降低（0.11%比 0.54%，p<0.0001）。与未使用 ICE 的患者相比，使用 ICE 的患者并发症降低 52%（HR[95%CI]；0.48[0.44-0.51]）。ICE 使用者的心脏并发症发生率也较低（3.67%比 4.51%；p=0.025）。在 AF 消融过程中使用 ICE 可显著增加住院费用（$98436±597 比 $81300±310；p<0.0001），但住院时间缩短（2.1±0.02 比 4±0.02 天；p<0.0001）。
在 AF 消融过程中使用 ICE 的比例逐年增加，与院内死亡率和手术并发症降低、住院时间缩短相关，但住院费用增加。
