Limitations
The present study has some limitations. Retrospective design limits the strength of our findings. Collection of data at a single center may result in treatment bias, which could influence the outcomes. However, our study cohort was representative of patients who undergo CA procedures for left-sided arrhythmias (1-3, 9-11, 17-19). We did not specifically assess the potential learning curve for completely ICE-based TSP and CA ablation without the use of fluoroscopy. With limited number of procedures and low complication rate it seems that our study is underpowered to predict potential risk factors for pericardial tamponade and other TSP-related complications. However, it is reasonable to assume that the use of ICE prevented some of the potential adverse events. Our findings in pediatric population and in patients with CIEDs should be interpreted with caution since the numbers were low. Finally, potential anatomical variations seen with ICE were not recorded systematically, which limits our estimation of additional benefits of ICE imaging. Further clinical studies are needed to establish cost-effectiveness and clinical benefits of entirely ICE-guided TSPs.