Prevention and Early Recognition of Complications During Catheter Ablation by Intracardiac Echocardiography

Chinese expert consensus on the construction of the fluoroless cardiac electrophysiology laboratory and related techniques

“…The types of complications occurring in the fluoroless EP lab are essentially the same as those in the traditional EP lab, and the probability of complications is correlated with the experience of the electrophysiologist. [42][43][44] Therefore, it is recommended that the electrophysiologist performing the procedure in the fluoroless EP lab should have some experience or be guided by an experienced electrophysiologist. In addition, the keys to ensuring the safety of This section will provide some recommendations for the management of serious and specific complications that may jeopardize patient safety in a fluoroless EP Lab, and the principles for management of other complications and the use of related drugs are the same as those in the traditional catheterization laboratory.…”

“…[45][46][47] Although most manifestations are self-limited, a few require surgical treatment and may even life-threatening in severe cases. [48][49][50][51][52] Prevention recommendations are as follows: (1) Vascular ultrasound guidance should be utilized for femoral vein puncture to avoid arterial injury; (2) Retroperitoneal hemorrhage in the left femoral vein puncture is significantly higher than with right femoral vein puncture, 49 so the right femoral vein puncture is preferred for vascular access; (3) The basic principles of ICE catheter operation should be strictly followed 40,44 to ensure that the cavity can be seen at the tip interface when ICE catheter enters, to avoid damage to the vessel wall or venous valve when the ICE catheter is pushed; (4) When a retroperitoneal hematoma does indeed occur, criteria for transfer to an appropriate level of care unit should be evaluated promptly and the bleeding location should be determined, and the treatment principles are otherwise the same as if occurring in the traditional catheterization laboratory.…”

“…Periprocedural complications of cardiac electrophysiological procedures are challenges in both the traditional EP lab and the fluoroless EP lab. The types of complications occurring in the fluoroless EP lab are essentially the same as those in the traditional EP lab, and the probability of complications is correlated with the experience of the electrophysiologist 42–44 . Therefore, it is recommended that the electrophysiologist performing the procedure in the fluoroless EP lab should have some experience or be guided by an experienced electrophysiologist.…”

Intracardiac echocardiography Chinese expert consensus

“…The application of ICE in catheter ablation can reduce the incidence of perioperative complications, especially the incidence of serious complications such as thromboembolism and cardiac tamponade (3,(55)(56)(57)(58)(59)(60)(61)(62)(63)(64), and shorten the average length of stay of patients (60). Studies have demonstrated that ICE-guided circumferential pulmonary vein ablation with the Carto-Sound system is safe and feasible in patients with atrial fibrillation compared with conventional X-ray radiography (65), and there was no significant difference in the incidence of complications such as puncture site hematoma and cardiac tamponade between the two groups (65)(66)(67).…”

“…Acute cardiac tamponade is one of the most common serious complications associated with catheter manipulation during ablation. ICE can detect early pericardial effusion along the lower ventricular border and posterior left atrium, which can be managed by reversing anticoagulant therapy to prevent cardiac tamponade ( 54 , 57 , 59 , 62 , 63 ). Meanwhile, pericardiocentesis can be performed as early as possible, with a drainage tube placed if necessary.…”