(J) Differences in Outcomes Among Patients with Atrial Fibrillation Undergoing Catheter Ablation with Versus Without Intracardiac Echocardiography Use

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1009

Presenting Author(s)

RAHUL KHANNA
– Johnson & Johnson, New Brunswick, New Jersey, United States

Co-Author(s)

Rhea C. Pimentel
– The University of Kansas Health System, United States
Neloufar Rahai
– Johnson & Johnson, United States
Sonia Maccioni, MPH
– Johnson & Johnson, United States

Background: Intracardiac echocardiography (ICE) use during catheter ablation procedure for atrial fibrillation (AF) has the potential to reduce complications and improve outcomes.

Objectives: To examine differences in complications and 12-month AF-related healthcare use among patients with AF undergoing ablation with versus without ICE use in a real-world setting.

Methods: The 2015-2020 IBM MarketScan® Commercial Database, a nationwide, administrative claims database of commercially insured non-elderly adults in the United States (US), was used for study purposes. Patients aged 18-64 years who underwent catheter ablation procedure with primary diagnosis of AF were identified, with first such ablation considered index ablation. Based on the presence or absence of ICE procedure codes during index ablation, patients were classified into with versus without ICE group. Outcomes including any complication (composite of cardiac perforation, acute coronary syndrome, ischemic stroke, and other complications) and 12-month AF-related inpatient admission, repeat catheter ablation, and cardioversion were compared among the two groups. Propensity score matching was used to match patients with versus without ICE use on study covariates. Cox proportional hazard model was used to compare outcomes among the matched study groups.

Results: There were 1,250 propensity matched patients identified in with versus without ICE group. Patients in ICE cohort had 50% lower risk of overall complications as compared to patients in non-ICE cohort (Hazard Ratio [HR] 0.50; 95% Confidence Interval [CI] 0.34-0.72). There appeared to be a higher rate of acute coronary events in the non-ICE cohort as compared to ICE cohort (2.77% vs 0.73%, p< 0.001). The ICE cohort had 36% lower risk of 12-month repeat catheter ablation as compared to non-ICE cohort (HR 0.64; 95% CI 0.49-0.83). No significant differences were observed in 12-month AF-related inpatient admissions and cardioversions among ICE and non-ICE cohorts.

Conclusions: The use of ICE during ablation procedures was associated with improved safety and effectiveness outcomes among patients with AF.