Use of a Novel 4D Intracardiac Echocardiography Catheter To Guide Interventional Electrophysiology Procedures

Introduction: Standard two-dimensional (2D), phased-array intracardiac echocardiography (ICE) is routinely used to guide interventional electrophysiology (EP) procedures. A novel four-dimensional (4D) ICE catheter (VeriSight Pro®, Philips, Andover, MA) can obtain 2D and three-dimensional (3D) volumetric images and cine-videos in real time (4D). The purpose of this study was to determine the early feasibility and safety of this 4D ICE catheter during EP procedures. Methods: The 4D ICE catheter was placed from the femoral vein in ten patients into various cardiac chambers to guide EP procedures requiring transseptal catheterization, including ablation for atrial fibrillation and left atrial appendage closure. 2D- and 3D- ICE images were acquired in real time by the electrophysiologist. A dedicated imaging expert performed digital steering to optimize and post-process 4D images. Results: Eight patients underwent pulmonary vein isolation (cryoballoon in 7 patients, pulsed field ablation in 1, additional radiofrequency left atrial ablation in 1). Two patients underwent left atrial appendage closure. High quality images of cardiac structures, transseptal catheterization equipment, guide sheaths, ablation tools, and closure devices were acquired with the ICE catheter tip positioned in the right atrium, left atrium, pulmonary vein, coronary sinus, right ventricle, and pulmonary artery. There were no complications. Conclusion: This is the first-in-human experience of a novel deflectable 4D ICE catheter used to guide EP procedures. 4D ICE imaging in safe and allows for acquisition of high-quality 2D and 3D images in real-time. Further use of 4D ICE will be needed to determine its added value for each EP procedure type.

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Radiofrequency Catheter Modification of Sinus Pacemaker Function Guided by Intracardiac Echocardiography

Circulation ◽

10.1161/01.cir.92.10.3070 ◽

1995 ◽

Vol 92 (10) ◽

pp. 3070-3081 ◽

Cited By ~ 63

Author(s):

Jonathan M. Kalman ◽

Randall J. Lee ◽

Westby G. Fisher ◽

Michael C. Chin ◽

Phillip Ursell ◽

...

Keyword(s):

Intracardiac Echocardiography ◽

Pacemaker Function

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Catheter ablation of short-coupled variant of torsade de pointes

Clinical Research in Cardiology ◽

10.1007/s00392-021-01840-z ◽

2021 ◽

Author(s):

Johannes Steinfurt ◽

Babak Nazer ◽

Martin Aguilar ◽

Joshua Moss ◽

Satoshi Higuchi ◽

...

Keyword(s):

Catheter Ablation ◽

Torsade De Pointes ◽

Intracardiac Echocardiography ◽

Long Term Results ◽

Electrical Storm ◽

3D Mapping ◽

Free Wall ◽

First Line ◽

First Line Therapy ◽

Line Therapy

Abstract Background The short-coupled variant of torsade de pointes (sc-TdP) is a malignant arrhythmia that frequently presents with ventricular fibrillation (VF) electrical storm. Verapamil is considered the first-line therapy of sc-TdP while catheter ablation is not widely adopted. The aim of this study was to determine the origin of sc-TdP and to assess the outcome of catheter ablation using 3D-mapping. Methods and results We retrospectively analyzed five patients with sc-TdP who underwent 3D-mapping and ablation of sc-TdP at five different institutions. Four patients initially presented with sudden cardiac arrest, one patient experienced recurrent syncope as the first manifestation. All patients demonstrated a monomorphic premature ventricular contraction (PVC) with late transition left bundle branch block pattern, superior axis, and a coupling interval of less than 300 ms. triggering recurrent TdP and VF. In four patients, the culprit PVC was mapped to the free wall insertion of the moderator band (MB) with a preceding Purkinje potential in two patients. Catheter ablation using 3D-mapping and intracardiac echocardiography eliminated sc-TdP in all patients, with no recurrence at mean 2.7 years (range 6 months to 8 years) of follow-up. Conclusion 3D-mapping and intracardiac echocardiography demonstrate that sc-TdP predominantly originates from the MB free wall insertion and its Purkinje network. Catheter ablation of the culprit PVC at the MB free wall junction leads to excellent short- and long-term results and should be considered as first-line therapy in recurrent sc-TdP or electrical storm. Graphic abstract

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Transcatheter Closure of PFO and ASD: Multimodality Imaging for Patient Selection and Perioperative Guidance

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8070078 ◽

2021 ◽

Vol 8 (7) ◽

pp. 78

Author(s):

Gabriele Egidy Assenza ◽

Luca Spinardi ◽

Elisabetta Mariucci ◽

Anna Balducci ◽

Luca Ragni ◽

...

Keyword(s):

Patient Selection ◽

Transcatheter Closure ◽

Multimodality Imaging ◽

Deep Understanding ◽

Volume Overload ◽

Arterial Embolization ◽

Ventricular Volume ◽

Intracardiac Echocardiography ◽

Technical Details ◽

Asd Closure

Transcatheter closure of patent foramen ovale (PFO) and secundum type atrial septal defect (ASD) are common transcatheter procedures. Although they share many technical details, these procedures are targeting two different clinical indications. PFO closure is usually considered to prevent recurrent embolic stroke/systemic arterial embolization, ASD closure is indicated in patients with large left-to-right shunt, right ventricular volume overload, and normal pulmonary vascular resistance. Multimodality imaging plays a key role for patient selection, periprocedural monitoring, and follow-up surveillance. In addition to routine cardiovascular examinations, advanced neuroimaging studies, transcranial-Doppler, and interventional transesophageal echocardiography/intracardiac echocardiography are now increasingly used to deliver safely and effectively such procedures. Long-standing collaboration between interventional cardiologist, neuroradiologist, and cardiac imager is essential and it requires a standardized approach to image acquisition and interpretation. Periprocedural monitoring should be performed by experienced operators with deep understanding of technical details of transcatheter intervention. This review summarizes the specific role of different imaging modalities for PFO and ASD transcatheter closure, describing important pre-procedural and intra-procedural details and providing examples of procedural pitfall and complications.

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