Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA.
Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA.
J Cardiovasc Electrophysiol. 2022 Sep;33(9):2015-2047. doi: 10.1111/jce.15599. Epub 2022 Jul 23.
Intracardiac echocardiography (ICE) use can lead to early detection of periprocedural complications and may improve patient outcomes by providing real-time visualization of catheter location and the treatment area during cardiac ablation (CA) for atrial fibrillation (AF).
Examine complications and 12-month healthcare use among patients with AF undergoing CA with versus without ICE use during the procedure in a real-world setting.
The 2015-2020 IBM MarketScan® Database was used to identify non-elderly adults (age 18-64 years) undergoing CA for AF. Patients were classified into ICE/non-ICE groups based on the presence or absence of ICE procedure codes. Patients in each group were matched on study covariates using propensity scores. Peri-procedural complications, 12-month cardiovascular (CV) or AF-related inpatient admission, repeat CA, and cardioversion were compared using a Cox proportional hazard model.
1371 patients were identified in each study cohort (ICE and non-ICE) after propensity matching. Patients who had CA with ICE had a significantly lower rate of complications than those without (2.9% vs. 5.8%; p < .001). The risk of complications was 50% lower with ICE use (hazard ratio [HR] 0.50; 95% confidence interval [CI] 0.34-0.72). For assessment of 12-month healthcare utilization, 1250 patients were identified in each cohort after propensity matching. ICE use was associated with a 36% lower risk of 12-month repeat ablation (HR 0.64; 95% CI 0.49-0.83). No differences in CV- or AF-related inpatient admission and cardioversion were observed.
Among patients with AF, the use of ICE during an ablation procedure was associated with lower incidence of complications and repeat ablation.
心内超声心动图（ICE）的使用可以早期发现围手术期并发症，并通过在心房颤动（AF）的心脏消融（CA）过程中实时可视化导管位置和治疗区域，改善患者的预后。
在真实环境中，检查在 CA 过程中使用与不使用 ICE 的情况下，接受 AF 治疗的患者的并发症和 12 个月的医疗保健使用情况。
使用 2015-2020 年 IBM MarketScan®数据库来识别接受 AF 的 CA 的非老年成年人（年龄 18-64 岁）。根据 ICE 手术代码的存在与否，将患者分为 ICE/非 ICE 组。使用倾向评分对每组患者进行研究协变量的匹配。使用 Cox 比例风险模型比较围手术期并发症、12 个月心血管（CV）或 AF 相关住院入院、重复 CA 和电复律。
在倾向匹配后，每个研究队列（ICE 和非 ICE）中都确定了 1371 名患者。与不使用 ICE 的患者相比，使用 ICE 的 CA 患者并发症发生率显著降低（2.9%比 5.8%；p<0.001）。ICE 使用率降低了 50%的并发症风险（风险比[HR]0.50；95%置信区间[CI]0.34-0.72）。对于 12 个月医疗保健利用的评估，在倾向匹配后，每个队列中都确定了 1250 名患者。ICE 的使用与 12 个月重复消融的风险降低 36%相关（HR 0.64；95%CI 0.49-0.83）。未观察到 CV 或 AF 相关住院入院和电复律的差异。
在 AF 患者中，消融过程中使用 ICE 与并发症发生率和重复消融率降低相关。
