Abstract 4367277: Intracardiac Echocardiography Use and Outcomes Following Catheter Ablation of Ventricular Tachycardia: A Meta-Analysis

Introduction: Intracardiac echocardiography (ICE) has emerged as a potentially valuable tool during ventricular tachycardia (VT), offering real-time visualization of cardiac anatomy and the catheter–tissue interface. Despite its theoretical benefits, data on the efficacy of ICE-guided VT ablation remains limited. We conducted a meta-analysis to systematically evaluate the impact of ICE on procedural success, complication rates, and long-term outcomes in VT ablation. Methods: A total of 1,616 studies were identified through a systematic search of PubMed and Embase up to May 2025. Three observational studies met the inclusion criteria and were included in the analysis. Primary outcomes included cardiovascular (CV)-related readmission, ventricular tachycardia (VT)-related readmission, major complications (cardiac tamponade, vascular injury, thromboembolism, major bleeding requiring transfusion), and repeat VT ablation. Using the Mantel-Haenszel method, a random-effects model was employed to calculate odds ratio (ORs) with corresponding 95% confidence intervals (CIs) for statistical significance. Higgins' I^2 was used to analyze heterogeneity. Results: Three studies involving 4,473 patients were included in the analysis. Ventricular tachycardia (VT) ablation guided by intracardiac echocardiography (ICE) was associated with a significantly lower incidence of cardiovascular (CV)-related readmissions (OR 0.78, 95% CI 0.67–0.92; p = 0.002). While VT ablation with ICE did not show any significant difference in major complications (OR 0.79, 95% CI 0.39–1.60; p = 0.5) , VT-related readmissions (OR 0.85, 95% CI 0.69–1.04; p = 0.10), and repeat VT ablation (OR 1.08, 95% CI 0.73–1.58; p = 0.71). Conclusion: Intracardiac echocardiography (ICE) use during catheter ablation of ventricular tachycardia (VT) showed reduced incidence of CV-related readmissions, however there were no significant statistical differences in VT- related readmissions, repeat VT ablation and major complications between the two groups. Further observational studies and RCTs are needed to better understand the benefits of intracardiac echocardiography in catheter ablation of ventricular tachycardia.