A prospective comparison of cardiac imaging using intracardiac echocardiography with transesophageal echocardiography in patients with atrial fibrillation: the intracardiac echocardiography guided cardioversion helps interventional procedures study.
BACKGROUND
The Intracardiac Echocardiography Guided Cardioversion Helps Interventional Procedures study evaluated the concordance of intracardiac echocardiography (ICE) with transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF).


RESULTS
Patients with AF undergoing right heart catheterization underwent left atrium (LA) and interatrial septal (IAS) imaging by TEE and ICE. A blinded comparison of the 2 modalities was performed at a core laboratory. Ninety-five patients aged 58 ± 12 years completed the study. The LA was profiled in all patients with both techniques, and concordance for image quality was 96%. LA appendage (LAA) imaging was achieved in 85% with ICE and 96% with TEE. There was no difference in the presence of spontaneous echo contrast between ICE and TEE during LA imaging, but there was a trend toward a greater incidence in the LAA with TEE (P = 0.109). Intracardiac thrombus was uncommonly seen (TEE, 6.9%; ICE, 5.2%). The concordance for the presence or absence of thrombus was 97% in the LA and 92% in the LAA, but the latter was detected more frequently with TEE. IAS imaging was achieved in 91% with ICE and in 97% with TEE (P = 0.177). Concordance for patent foramen ovale and atrial septal aneurysms was 100% and 96%, respectively. A negative ICE examination was associated with absence of dense echo contrast or thrombus on TEE in 86%.


CONCLUSIONS
This study provides validation for the use of ICE for LA and IAS imaging. ICE imaging was less sensitive compared to TEE for LAA thrombus identification. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00281073.
Saksena
Sanjeev
S
ICE-CHIP Study Participating Institutions, Electrophysiology Research Foundation, Warren, NJ 07059, USA.
Sra
Jasbir
J
Jordaens
Luc
L
Kusumoto
Fred
F
Knight
Bradley
B
Natale
Andrea
A
Kocheril
Abraham
A
Nanda
Navin C
NC
Nagarakanti
Rangadham
R
Simon
Ann Marie
AM
Viggiano
Mary A
MA
Lokhandwala
Tasneem
T
Chandler
Mary L
ML
D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006328:Cardiac Catheterization; D003937:Diagnosis, Differential; D004311:Double-Blind Method; D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000000981:diagnostic imaging; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional