Outcomes of ventricular tachycardia ablation with intracardiac echocardiography-a retrospective cohort study of the national inpatient sample

Abstract Background Intracardiac echocardiography (ICE) is being increasingly used in VT ablation. Sparse literature indicates that ICE reduces repeat VT ablation and VT-related admissions (1). Objective To determine if ICE reduced procedural complications, mortality, length of stay, and hospitalization costs in VT ablation. Methods Utilizing the National Inpatient Sample (NIS) of the years 2016 to 2020, we compared the differences between patients who had VT ablation with and without ICE. We used multivariable logistic and linear regression models as appropriate to determine if ICE was associated with improved outcomes as defined above. Results We included 15,480 hospitalizations (95% CI 14,513-16,446) with VT ablations. ICE was used in 1815 (11.7%) of the patients. The mortality rate was 2.2%(95% CI 1.1-4.3) in the ICE group and 3.2% (95% CI 2.6-3.9) in the non-ICE group, and composite complications rate was 18.4% (95% CI 14.7-22.7) in the ICE group and 19.2% (17.7-20.8) in the non-ICE group. On univariate and multivariate analysis, ICE was not associated with a decrease in mortality, composite complications, or hospitalization charges but with a reduction in length of stay (Tables 1 and 2). ICE was associated with sepsis on univariate analysis but not on multivariate analysis (aOR 0.51, 95% CI 0.26-1.00, P=0.051) Conclusion Our study demonstrates that ICE was not associated with a reduction in mortality or complications in VT ablation but was associated with a slightly shorter length of stay. Although our observational study did not demonstrate a major benefit with ICE, given the multiple advantages of ICE in VT ablations, such as real-time recognition of myocardial substrate, identification of anatomical structures to guide ablation, and prompt recognition of intra-procedural complications, we recommend randomized controlled studies to evaluate the efficacy of ICE(2). Our study is limited by its retrospective nature and reliance on ICD codes for data extraction.