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Intracardiac echocardiography (ICE) has emerged as an adjunctive tool during electrophysiological procedures. The objective of this study was to validate ICE for assessing atrial mechanical function in patients with atrial fibrillation (AF) by comparing the parameters of atrial mechanical function assessed by transoesophageal echocardiography (TOE) versus ICE. This study enrolled 23 patients (20 men; mean (SD) age 56 (12) years) undergoing ablation of symptomatic drug refractory AF: 11 patients with paroxysmal and 12 with persistent AF of > 6 months’ duration. The left anteroposterior atrial size was 45 (8) mm and left ventricular ejection fraction was 63 (13)%. All patients were prospectively enrolled after providing written informed consent. TOE was performed on the day of the ablation procedure with a Hewlett Packard Sonos 2500 or 5000 or an Acuson Sequoia workstation connected to a multiplane 5–7.5 MHz probe. ICE imaging was performed at the start of the ablation procedure. A 10 French ICE catheter with a 5–10 MHz probe was connected to an Acuson Sequoia workstation. In five patients without adequate imaging of the left atrial appendage (LAA) from the right atrium, the catheter was advanced into the left atrium through a patent foramen ovale or a transseptal puncture. All parameters were measured according to established clinical laboratory practice and were recorded on videotape or digitally for offline analysis. The following parameters were determined by TOE and ICE: LAA emptying velocity (LAAEV); maximum mitral E wave velocity; left …