Fluoroless ablation of atrial fibrillation using intracardiac ultrasound integrated with 3D electroanatomical mapping system

Funding Acknowledgements Type of funding sources: None. Introduction Intracardiac echocardiography (ICE) is gaining increasingly wider adoption in interventional electrophysiology (EP) and represents an all-round tool for ablation of atrial fibrillation (AF). The key upgrade to the usefulness of ICE is its integration into three-dimensional (3D) electroanatomic mapping (EAM) system (ICE/EAM automatic integration system). Purpose The aim of this single-centre retrospective study was to evaluate feasibility, safety and acute efficacy of ICE/EAM automatic integration system guided fluoroless ablation of AF. Methods Patients with symptomatic paroxysmal or persistent AF referred for first pulmonary vein isolation (PVI) radiofrequency catheter ablation (RFCA) from September 2017 to August 2020 were included in the study. Those who underwent additional ablations for concomitant arrhythmias were excluded from statistical analysis. 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. PVI was performed with contact force (CF) sensing catheter. Procedural endpoint was successful PVI. Results A total of 56 patients underwent RFCA (35.7% females, median age 62.7 years, 53.6% paroxysmal AF). Acute PVI was achieved in all patients (100%). Adverse events were detected in two patients (3.6%). The median procedure duration was 110.5 min (IQR 100.0-133.8). First-pass isolation was achieved in 50/56 LPVs (89.3%) and in 44/56 RPVs (78.6%). In patients where first-pass isolation was no achieved, intravenous carina had to be ablated in 3/6 (50%) of LPVs and 9/12 (75%) of RPVs. Conclusions Flouroless PVI using ICE/EAM automatic integration system is feasible, safe and acutely effective. We achieved high rate of first-pass isolation.

Left-Sided Pulmonary Isolations After Complete Right-Sided Pneumonectomy: Technical Challenges to Clinical Success

Male patient, 76 years old, presented symptomatic paroxysmal AF for almost 2 years. Long submitted to total right pneumonectomy and having a major cardiac rotation. The use of tomography and intracardiac ultrasound were fundamental for a better anatomic comprehension and optimization of the safety procedures for AF ablation in these patients, due to the difficulty in accessing the left atrium and the consequent manipulation of catheters. In this case, electrical signals have not yet been detected in the stumps on the right side, with only the left veins being isolated. This approach constitutes a new approach in this clinical situation, with clinical success in a 3-year follow-up.

Meta analysis of transcatheter closure of atrial septal defect/patent foramen ovale guided by intracardiac echocardiography and transesophageal echocardiography

Background.Data on the effectiveness and safety of percutaneous transcatheter closure of atrial septal defect(ASD) and patent foramen ovale(PFO) guided by intracardiac ultrasound(ICE) are limited. We conducted a meta-analysis comparing intracardiac ultrasound with transesophageal ultrasound(TEE) guided surgery. Mehood.From 1996 to 2020, a systematic search was conducted using multiple databases, and the results were operation time, fluoroscopy time, success rate, complications, and occluder size. Results.7 studies were included, with a total sample size of 971 patients, of which 448 patients were treated with atrial defect occlusion guided by ICE, and the other 523 patients were treated with atrial septal occlusion guided by TEE. There was a statistical difference in the fluoroscopy time and procedure time between the ICE group and the TEE group, (P<0.01), There was no significant difference in success rate, complication between ICE and TEE groups (successrate, P=0.71; complications, P=0.51). Conclusion. success rate, complications and occluder size were similar between ICE group and the TEE group. Fluoroscopy time, procedure time were significantly reduced for transcatheter closure of atrial septal defect guided by intracardiac ultrasound.