Intracardiac echocardiography during catheter ablation of atrial fibrillation

Abstract

Catheter-based radiofrequency ablation with pulmonary vein (PV) isolation has emerged as an effective therapy for patients with symptomatic atrial fibrillation. Real-time intracardiac echocardiography with two-dimensional and Doppler colour flow imaging can facilitate left heart ablation procedures. It allows identification of anatomic structures and potential anatomic variations. It has a critical role for guiding transseptal catheterization, assisting placement of mapping and ablation catheters, and allows for titration of energy delivery. More importantly, it allows identification and potential reduction of procedural complications including damage to intracardiac structures, left atrial thrombus formation, PV stenosis, and pericardial effusion during left heart ablation.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…762,763,764,765,766,767 Advocates of the use of ICE find it to be of value because it can (1) help identify anatomical structures relevant to ablation, including the PVs and esophagus; (2) facilitate transseptal access and allow selective puncture in various regions of the fossa; (3) guide accurate placement of the multielectrode circular ablation catheter and/or balloon-based ablation system; (4) allow titration of the delivered energy; (5) provide feedback about catheter contact; (6) allow for recognition of thrombus formation on sheaths and catheters; and (7) allow early recognition of cardiac perforation and/or development of a pericardial effusion. 767,768 Some centers also use ICE to screen for the presence of LAA thrombus, because it has been shown to be comparable to transesophageal echocardiogram (TEE) when performed by experienced operators.…”

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

“…ICE, which allows for real-time imaging of cardiac anatomy, is used in many EP laboratories throughout the world to facilitate AF ablation procedures [91,[314][315][316][317]. Advocates of the use of ICE find it to be of value as it can (1) help identify anatomic structures relevant to ablation, including the PVs and esophagus, (2) facilitate transseptal access, (3) guide accurate placement of the multielectrode circular ablation catheter and/or balloon-based ablation system, (4) allow titration of delivered energy, (5) allow for recognition of thrombus formation on sheaths and catheters [318], and (6) allow early recognition of cardiac perforation and/or the development of a pericardial effusion.…”

Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation

“…Furthermore, it has helped to improve anticoagulation regimes [18]. The use of ICE has improved success rate [19]. It may supplant fluoroscopy as the gold standard for precise imaging of endocardial structures during ablation of AF [20] and even catheter ablation of AF without fluoroscopy only using ICE and electroanatomic mapping has been successfully evaluated [21].…”