BACKGROUND: Routine radiofrequency catheter ablation relies on x-ray imaging, which may increase the risk of radiation exposure to patients. With the rapid development of intracardiac echocardiography (ICE) technology, it provides a new guidance modality for radiofrequency catheter ablation and shows great potential for application in the treatment of atrial fibrillation (AF). OBJECTIVE: To assess the efficacy and safety of intracardiac echocardiography guided radiofrequency catheter ablation for the treatment of AF. METHODS: A retrospective cohort study was used to collect 184 patients who underwent radiofrequency catheter ablation for the treatment of AF from January 2020 to September 2021 in the cardiovascular medicine department of our hospital. According to whether they used ICE or not, they were divided into the ICE group (30 cases) and the non-ICE group (154 cases). The procedure of the intervention, complications during the intervention and follow-up periods, use of early anticoagulation and antiarrhythmic medications, and the success rate of AF ablation 1 year after the intervention were compared between the two groups. RESULTS: In comparison to the non-ICE group, the septal puncture time (6.27 ± 1.91 min vs. 7.21 ± 2.08 min, p = 0.022), left atrial modeling time (4.93 ± 1.84 min vs. 5.75 ± 1.96 min, p = 0.035), and total ablation time (67.73 ± 2.64 min vs. 73.35 ± 1.96 min, p <
0.001) in the ICE group were significantly reduced. Radiation exposure time (5.09 ± 0.23 min vs. 13.17 ± 0.28 min, p <
0.001) and radiation exposure (33.13 ± 1.99 mGy/cm CONCLUSION: ICE-guided radiofrequency catheter ablation is safe and effective in the treatment of AF, and it has potential advantages in terms of ablation time, radiation exposure, complication occurrence, and patient prognosis.