Combined use of electro-anatomic mapping system and intracardiac echocardiography to achieve zero-fluoroscopy catheter ablation for treatment of paroxysmal atrial fibrillation: a single centre experience

Jan, Matevž; Žižek, David; Kuhelj, Dimitrij; Lakič, Nikola; Kalinšek, Tine Prolič; Štublar, Jernej; Klemen, Luka; Pernat, Andrej; Antolič, Bor

doi:10.1007/s10554-019-01727-1

Cited by 19 publications

(12 citation statements)

References 30 publications

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“…The application of ICE during AF ablation has increased over the years and is associated with lower procedural complications and in‐hospital mortality 14 . Several studies to date have evaluated the feasibility and outcome of zero‐fluoroscopy catheter ablation of AF with combined use of a three‐dimensional electro‐anatomic mapping system and ICE 15,16 . Our study applied the currently available technologies: ICE, CartoSound electroanatomical mapping system, and contact force sensing catheter, along with high power ablation strategy 17 and AI guidance 18 .…”

Section: Discussionmentioning

confidence: 99%

“…14 Several studies to date have evaluated the feasibility and outcome of zero-fluoroscopy catheter ablation of AF with combined use of a three-dimensional electro-anatomic mapping system and ICE. 15,16 Our study applied the currently available technologies: ICE, CartoSound electroanatomical mapping system, and contact force sensing catheter, along with high power ablation strategy 17 and AI guidance. 18 This study demonstrated that AI-guided high-power fluoroless ablation for AF under ICE guidance is fully effective and safe.…”

Section: Efficacy and Safety Of Ai-guided High-power Fluoroless Af Ab...mentioning

confidence: 99%

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Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Chen

Wang

Zhou

et al. 2022

Cardiovasc electrophysiol

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Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) are sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. We aim to evaluate the clinical outcomes and safety of ICE-guided LAAC within a zerofluoroscopy catheter ablation procedure.Methods and Results: From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC were achieved in all patients.Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 75.0% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA 2 DS 2 -VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Efficacy and Safety Of Ai-guided High-power Fluoroless Af Ab...mentioning

confidence: 99%

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Chen

Wang

Zhou

et al. 2022

Cardiovasc electrophysiol

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“…Fluoroless PVI for paroxysmal and persistent AF or more complex arrhythmias such as LA flutter utilizing ICE imaging and EAM has been reported elsewhere 10,11,12,20 . In contrast to these studies, we used ICE/EAM automatic integration system as the primary tool for reconstructing detailed virtual anatomical 3D map of all relevant LA structures.…”

Section: Discussionmentioning

confidence: 99%

Integrated 3D intracardiac ultrasound imaging with detailed pulmonary vein delineation guided fluoroless ablation of atrial fibrillation

Antolič

Kajdič

Vrbajnscak

et al. 2021

Pacing Clinical Electrophis

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Background Intracardiac echocardiography (ICE) has become an all‐round tool for ablation of atrial fibrillation (AF) since it plays an important role in all procedural steps. The key upgrade to the usefulness of ICE is its integration into three‐dimensional (3D) electroanatomic mapping (EAM) system (ICE/EAM automatic integration system). The aim of this single‐center retrospective study was to evaluate feasibility, safety and acute efficacy of ICE/EAM automatic integration system guided fluoroless ablation of AF. Methods The study included patients with symptomatic paroxysmal or persistent AF undergoing first pulmonary vein isolation (PVI) radiofrequency (RF) catheter ablation (RFCA) from September 2017 to August 2020. All procedures were performed without the use of fluoroscopy. A detailed 3D virtual anatomy of the left atrium (LA) and structures relevant to AF ablation was constructed from ultrasound contours obtained with ICE probe inside the LA. Pulmonary veins (PVs) and antral regions were additionally mapped with fast anatomical mapping (FAM). PVI was performed with contact force (CF) sensing catheter. Procedural endpoint was successful PVI. Results A total of 98 consecutive patients underwent RFCA (34.7% females, median age 64.4 years, 64.3% paroxysmal AF). Acute PVI was achieved in all patients (100%). Forty‐three patients (43.9%) underwent additional ablations for concomitant arrhythmias. Adverse events were detected in four patients (4.1%). The median procedure duration was 130 min (IQR 103.8‐151.3). If only PVI was done the median procedure duration was 110.5 (IQR 100.0‐133.8) Conclusions ICE/EAM automatic integration system guided fluoroless ablation of AF is feasible, safe and acutely effective method for treatment of symptomatic AF.

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“…14 Very few studies to date have evaluated the feasibility and outcome of zero-fluoroscopy catheter ablation of AF with combined use of a three-dimensional electroanatomic mapping system and ICE. 15,16 Our study applied the currently available technologies: ICE, CAR-TOSOUND electroanatomical mapping system and contact force sensing catheter, along with high power ablation strategy 17 and AI guidance 18 . This study demonstrated that AI-guided high-power fluoroless ablation for AF under ICE guidance is fully effective and safe.…”

Section: Discussionmentioning

confidence: 99%

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero-fluoroscopy atrial fibrillation ablation procedures

Chen

Wang

Zhou

et al. 2021

Preprint

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Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) is sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. To evaluate the clinical outcomes and safety of ICE guided LAAC within a zero-fluoroscopy catheter ablation procedure. Methods and Results:From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC was achieved in all patients. Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 77.8% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA2DS2-VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to a single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

show abstract

Combined use of electro-anatomic mapping system and intracardiac echocardiography to achieve zero-fluoroscopy catheter ablation for treatment of paroxysmal atrial fibrillation: a single centre experience

Cited by 19 publications

References 30 publications

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Integrated 3D intracardiac ultrasound imaging with detailed pulmonary vein delineation guided fluoroless ablation of atrial fibrillation

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero-fluoroscopy atrial fibrillation ablation procedures

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