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.