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Chatani R, Tasaka H, Kubo S, Yoshida K, Yoshino M, Maruo T, Kadota K. Intracardiac echocardiography guided simultaneous atrial fibrillation ablation and Micra implantation 14 days after Watchman FLX implantation. Clin Case Rep 2024; 12:e8906. [PMID: 38751959 PMCID: PMC11093898 DOI: 10.1002/ccr3.8906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
Key Clinical Message Atrial fibrillation ablation, including pulmonary vein isolation immediately after left atrial appendage closure (LAAC), is a rare and challenging issue. Intracardiac echocardiography guidance can help identify the LAAC device position for safe atrial fibrillation ablation without LAAC device-related adverse events even immediately after LAAC device implantation. Abstract Early phase atrial fibrillation (AF) ablation after left atrial appendage closure (LAAC) is a rare and challenging issue. Here, we present a case illustrating the feasibility of AF ablation under intracardiac echocardiography guidance immediately after LAAC device implantation without LAAC device-related adverse events.
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Affiliation(s)
- Ryuki Chatani
- Department of Cardiovascular MedicineKurashiki Central HospitalkurashikiJapan
| | - Hiroshi Tasaka
- Department of Cardiovascular MedicineKurashiki Central HospitalkurashikiJapan
| | - Shunsuke Kubo
- Department of Cardiovascular MedicineKurashiki Central HospitalkurashikiJapan
| | - Kenta Yoshida
- Department of Cardiovascular MedicineKurashiki Central HospitalkurashikiJapan
| | - Mitsuru Yoshino
- Department of Cardiovascular MedicineKurashiki Central HospitalkurashikiJapan
| | - Takeshi Maruo
- Department of Cardiovascular MedicineKurashiki Central HospitalkurashikiJapan
| | - Kazushige Kadota
- Department of Cardiovascular MedicineKurashiki Central HospitalkurashikiJapan
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Haskova J, Peichl P, Borisincova E, Kautzner J. Case Report: Pulsed field ablation for epicardial right-sided accessory pathway. Front Cardiovasc Med 2024; 11:1392264. [PMID: 38737710 PMCID: PMC11082373 DOI: 10.3389/fcvm.2024.1392264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
We present a case of a 32-year-old male with a history of palpitations and preexcitation on ECG who underwent altogether four failed catheter ablations using different approaches in the two other electrophysiology centers within two years. ECG showed overt preexcitation with a positive delta wave in lead I and negative in leads V1-V3, suggesting a right free wall accessory pathway. During the electrophysiological study, the accessory pathway was localized on the free lateral wall. However, the electrograms and mapping during atrial and ventricular pacing suggested the presence of true epicardial accessory pathway. Repeated radiofrequency energy delivery with the support of the steerable sheath and excellent contact (as assessed by intracardiac echocardiography) at the earliest ventricular activation was not successful. Therefore, the Farawave catheter (Boston Scientific, Inc) was used, and a flower configuration with the intention to cover the entire atrial attachment of the pathway during ventricular pacing was selected. Application of pulsed field resulted in interruption of accessory pathway conduction. An electrophysiological study one year later confirmed the persistent effect of ablation. This case illustrates the potential utility of pulsed field energy for the ablation of atrial insertion of the accessory pathway with an epicardial course. Such an approach can avoid epicardial mapping and access and may improve the safety of the procedure.
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Affiliation(s)
- Jana Haskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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3
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Stout K, Craig C, Rivington J, Lyden E, Payne JJ, Goldsweig AM. Clinical Protocol for Selecting Intracardiac or Transesophageal Echocardiography-Guided Left Atrial Appendage Occlusion. Am J Cardiol 2024:S0002-9149(24)00284-4. [PMID: 38642870 DOI: 10.1016/j.amjcard.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
Intracardiac echocardiography (ICE) has emerged as an alternative to transesophageal echo (TEE) to guide left atrial appendage occlusion (LAAO). We established a protocol to select patients appropriate for ICE guidance. Patients who underwent LAAO with the Watchman or Watchman FLX device (Boston Scientific, Marlborough, Massachusetts) from January 2018 to March 2022 at a large United States center were included. The novel protocol prospectively selected TEE or ICE guidance beginning in January 2020; previous LAAO procedures were retrospectively included. ICE was selected for patients with uninterrupted anticoagulation and appropriate LAA anatomy, renal function, and moderate sedation tolerance. In-hospital outcomes with successful implantation without conversion to TEE guidance, no peridevice leak, and no procedural complications were compared. Composite 1-year outcome included freedom from peridevice leak, device-related thrombus, stroke, and all-cause mortality. A total of 234 patients were included; the mean age was 76.1 ± 8.3 years old, and 42.3% were female. ICE guidance was used for 63 procedures; TEE guidance was used for 171 procedures. For the composite outcome, ICE-guided LAAO was superior to TEE-guided LAAO (risk difference 0.102, 96.8% vs 86.5%, 95% confidence interval 0.003 to 0.203, p = 0.029). In comparison to the TEE-guided group, ICE-guided procedures were shorter (89.1 ± 26.3 vs 99.8 ± 30.0 min, p = 0.0087) with less general anesthesia (26.6% vs 98.8%, p <0.0001). One-year composite adverse outcomes did not differ significantly (80.7% vs 88.9%, p = 0.17). In conclusion, the protocol to select appropriate patients for ICE versus TEE guidance for LAAO is safe and effective. Larger studies are indicated to validate this approach to improve outcomes, shorten procedures, and avoid general anesthesia.
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Affiliation(s)
- Kara Stout
- Division of Cardiovascular Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Calvin Craig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jaclyn Rivington
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jason J Payne
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska; Department of Cardiology, Baystate Medical Center, Springfield, Massachusetts
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Passaniti G, Safi LM, Prandi F, Ratanapo S, Lerakis S, Tang GHL, Krishnamoorthy P. Fundamental Roles of Intracardiac Echocardiography and Fluoroscopy in Redo Tricuspid Transcatheter Edge-to-Edge Repair Procedure. JACC Cardiovasc Interv 2024; 17:933-935. [PMID: 38456880 DOI: 10.1016/j.jcin.2024.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Giulia Passaniti
- Mount Sinai Fuster Heart Hospital, New York, New York, USA; Centro Alte Specilaitae Trapianti, University of Catania, Catania, Italy
| | - Lucy M Safi
- Mount Sinai Fuster Heart Hospital, New York, New York, USA
| | - Francesca Prandi
- Mount Sinai Fuster Heart Hospital, New York, New York, USA; Tor Vergata University, Rome, Italy
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Kusume T, Okano T, Onishi M, Terasawa M, Yazaki Y, Satomi K. Second Micra leadless pacemaker implantation by using intracardiac echocardiography. Pacing Clin Electrophysiol 2024; 47:554-557. [PMID: 37377404 DOI: 10.1111/pace.14770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
The strategy after battery depletion was not established in Micra leadless pacemaker system (Micra). There are still some concerns in the 2nd Micra implantation, such as the mechanical interaction between both devices. The position of the 2nd Micra should be placed apart from the 1st Micra. We present a case of 1st Micra battery depletion who successfully underwent the 2nd Micra implantation under the intracardiac echo guidance. In our case, intracardiac echo was a very effective tool for confirming the location of Micra implantation.
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Affiliation(s)
- Takahiro Kusume
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomoya Okano
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masahumi Onishi
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Muryo Terasawa
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshinao Yazaki
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Satomi
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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Hamid N, Aman E, Bae R, Scherer M, Smith TWR, Schwartz J, Rinaldi M, Singh G, Sorajja P. 3D Navigation and Intraprocedural Intracardiac Echocardiography Imaging for Tricuspid Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Imaging 2024; 17:441-447. [PMID: 38569794 DOI: 10.1016/j.jcmg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Nadira Hamid
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
| | - Edris Aman
- University of California Davis Medical Center, Sacramento, California, USA
| | - Richard Bae
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Markus Scherer
- Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Thomas W R Smith
- University of California Davis Medical Center, Sacramento, California, USA
| | | | | | - Gagan Singh
- University of California Davis Medical Center, Sacramento, California, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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Jaganathan N, Devarapalli M, Kumar V. Optimizing Perioperative Care for Ventricular Tachycardia Ablation in High-Risk Patients Supported by Impella 5.5. Cureus 2024; 16:e58642. [PMID: 38770455 PMCID: PMC11103450 DOI: 10.7759/cureus.58642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Impella 5.5 (Abiomed Inc., Danvers, MA, USA) is a surgically implanted mechanical circulatory support device that helps support hemodynamically compromised patients. The device's risks and benefits must be entirely known, especially in the electrophysiology lab. Due to unexpected hemodynamic changes during pace mapping and ablation, such as ventricular tachycardia (VT) and asystole, it is sometimes necessary to implement chemical support with inotropic agents such as epinephrine or mechanical support with devices such as an Impella. We present the case of a 72-year-old male with a biventricular implantable cardioverter-defibrillator (ICD) (Medtronic, Minneapolis, MN, USA) placed for refractory VT presenting for VT ablation. He had ischemic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 33% and medical history of cardiac sarcoidosis, hypertension, hyperlipidemia, pulmonary embolism, left bundle branch block, and coronary artery disease. Due to the nature of the procedure and his history of arrhythmia, the patient was deemed a candidate for Impella 5.5. After evaluating patient risk factors, the cardiothoracic anesthesia team developed a strategic approach with imaging (including radiographic and echocardiographic imaging), Impella monitoring, and pharmacologic management with inotropes and vasopressors, allowing for uncomplicated perioperative management during the ablation. Given the procedure's intricacies and the patient's arrhythmia history, the medical team identified the patient as suitable for Impella 5.5 due to better performance and greater cardiac output than Impella 2.5 (Abiomed Inc., Danvers, MA, USA). Following a thorough assessment of the patient's risk factors, the cardiothoracic anesthesia team devised a comprehensive strategy to facilitate smooth perioperative management during the ablation, minimizing complications. The VT ablation procedure was performed successfully and effectively terminated the arrhythmia. However, the patient developed multifaceted postoperative complications, including cardiogenic shock, hemorrhagic shock, dyspnea, anemia, gastrointestinal abnormalities, and sepsis. This case represents a highly complex patient scenario under the care of the cardiovascular anesthesiologist due to the nature of the procedure and numerous cardiovascular comorbidities, low ejection fraction, ICD placement, and malignant ventricular arrhythmia. We discuss the various perioperative management strategies and how they are tailored to such patients, including pharmacologic intervention, anesthesia administration, imaging modalities, and postoperative care. The purpose of this case report is to delineate the role of Impella 5.5 in perioperative care for high-risk VT ablation patients. We discuss the progression, pathophysiology, and management of this patient's multisystem complications following the procedure. We also highlight the use of Impella 5.5 in the electrophysiology lab and the anesthesia considerations, safeguards, and management strategies to optimize perioperative outcomes and avoid complications.
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Affiliation(s)
- Nikhil Jaganathan
- Anesthesiology and Perioperative Medicine, Augusta University Medical College of Georgia, Augusta, USA
| | - Mallikarjuna Devarapalli
- Anesthesiology and Perioperative Medicine, Augusta University Medical College of Georgia, Augusta, USA
| | - Vikas Kumar
- Anesthesiology and Perioperative Medicine, Augusta University Medical College of Georgia, Augusta, USA
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Pernat A, Zavrtanik M, Robles AG, Romano S, Sciarra L, Antolič B. Assessment of Esophageal Shifts during Catheter Ablation of Atrial Fibrillation Using Intracardiac Ultrasound Integrated with 3-Dimensional Electroanatomical Mapping System. J Cardiovasc Dev Dis 2024; 11:110. [PMID: 38667728 PMCID: PMC11050422 DOI: 10.3390/jcdd11040110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Purpose: Atrioesophageal fistula is one of the most feared complications of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) as it is associated with high mortality. Determining the esophagus location during RFCA might reduce the risk of esophageal injury. The present study aims to evaluate the feasibility of using intracardiac echocardiography integrated into a 3-dimensional electroanatomical mapping system (ICE/3D EAM) for the assessment of esophageal position and shifts in response to ablation. Methods: We prospectively enrolled 20 patients that underwent RFCA of AF under conscious analgosedation. The virtual anatomy of the left atrium, the pulmonary vein (PV) ostia, and the esophagus was created with ICE/3D EAM. The esophageal positions were obtained at the beginning of the procedure and then after left and right PV isolation (PVI). Esophageal shifts were measured offline after the procedure using the tools available in the 3D EAM system. Results: Most esophagi moved away from the ablated PV ostia. After the left PVI, the median of the shifts was 2.8 mm (IQR 1.0-6.3). In 25% of patients, the esophagus shifted by >5.0 mm (max. 13.4 mm). After right PVI, the median of shifts was 2.0 mm (IQR 0.7-4.9). In 10% of patients, the esophageal shift was >5.0 mm (max. 7.8 mm). Conclusions: ICE/3D EAM enables the intraprocedural visualization of baseline esophageal position and its shifts after PVI. The shifts are variable, but they tend to be small and directed away from the ablation site. Repeated intraprocedural visualization of the esophagus may be needed to reduce the risk of esophageal injury.
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Affiliation(s)
- Andrej Pernat
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.Z.); (B.A.)
| | - Mark Zavrtanik
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.Z.); (B.A.)
| | - Antonio Gianluca Robles
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.Z.); (B.A.)
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.R.); (L.S.)
- Department of Cardiology, “L. Bonomo” Hospital, ASL BAT, 76123 Andria, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.R.); (L.S.)
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.R.); (L.S.)
| | - Bor Antolič
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.Z.); (B.A.)
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Vernemmen I, Van Steenkiste G, Buschmann E, Cornelis K, Schauvliege S, Ibrahim L, Decloedt A, van Loon G. Development of an atrial transseptal puncture procedure in horses to access the left heart: An ultrasound-guided jugular vein and transhepatic approach. Equine Vet J 2024. [PMID: 38522423 DOI: 10.1111/evj.14084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Radiofrequency ablation has been successfully applied to treat right atrial arrhythmias in horses. Ablation of left-sided arrhythmias requires a retrograde transarterial approach which is complicated. In human medicine, the left atrium is accessed through transseptal puncture (TSP) of the fossa ovalis (FO) using a caudal approach via the femoral vein. OBJECTIVES To develop a zero fluoroscopy TSP technique for horses using a jugular vein (cranial) and transhepatic (caudal) approach. STUDY DESIGN In vivo experimental study. METHODS Transseptal puncture was performed in 18 horses admitted for euthanasia and donated for scientific research under general anaesthesia: using a jugular vein approach (10 horses), a transhepatic approach (2 horses) or both (6 horses). Radiofrequency energy was applied on a guidewire to perforate the FO and allow sheath advancement under intracardiac and transthoracic echocardiographic guidance. Puncture lesions were inspected post-mortem. RESULTS Transseptal puncture was successful in 17/18 horses, of which 15/16 jugular vein approaches and 5/8 transhepatic approaches. Failure was due to technical malfunction, inability to advance the guidewire toward the heart and inability to advance the sheath through the FO. Intracardiac echocardiography was essential to safely guide the puncture process. Atrial arrhythmias caused by the TSP occurred in 13/18 horses. Puncture lesions were found in the right atrium in the FO region, and left atrium ventral to pulmonary vein ostium III. MAIN LIMITATIONS Because in several horses two approaches were tested consecutively, it cannot be excluded that the second TSP was performed at the previous puncture site. Due to the developmental nature of the study the approaches were not randomised and did not allow comparison. CONCLUSION Transseptal puncture is feasible in horses using ultrasound guidance and allows for electrophysiological exploration of the left heart. Further studies are needed to evaluate post-operative follow-up.
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Affiliation(s)
- Ingrid Vernemmen
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Kristoff Cornelis
- Cardiology Department, Maria Middelares Heart Centre, Ghent, Belgium
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Lara Ibrahim
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Goyal SK, Bhimani AA, Kella DK, Tyagi A, Polsani V, Deering TF. Inter-atrial septal balloon dilation to facilitate intracardiac echocardiography guided left atrial appendage occlusion. J Cardiovasc Electrophysiol 2024. [PMID: 38509774 DOI: 10.1111/jce.16243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Percutaneous left atrial appendage occlusion (LAAO) is traditionally performed under general anesthesia with trans-esophageal echocardiography guidance. Intracardiac echo (ICE)-guided LAAO closure is increasing in clinical use. The ICE catheter is crossed into LA via interatrial septum (IAS) after the septum is dilated with LAAO delivery sheath. This step can be time-consuming and requires significant ICE catheter manipulation, which increases the risk of cardiac perforation. Pre-emptive septal balloon dilation can potentially help with ICE advancement in the LA. We sought to evaluate the effect of pre-dilation of the IAS with an 8 mm balloon on the ease of crossing the ICE catheter, fluoroscopy time for crossing, and overall procedure time. METHODS The Piedmont LAAO registry was used to identify consecutive patients who underwent LAAO. The initial 25 patients in whom balloon dilation of the IAS was performed served as the experimental cohort, and the 25 consecutive patients before that in whom balloon dilation was not performed served as controls. In the experimental group, after a trans-septal puncture, the sheath was retracted to the right atrium with a guidewire still in the LA. An 8 × 40 mm Evercoss™ over the wire balloon was inflated across the IAS. The ICE catheter was then crossed into the LA using the fluoroscopic landmark of the guide wire and the ICE imaging. The sheath was then advanced along the ICE catheter via the transseptal puncture (TSP) and the procedure continued. Follow-up compputed tomography imaging was obtained at 4-8 weeks. RESULTS Each group consisted of 25 patients. There were no significant differences in baseline characteristics. All procedures were performed successfully under conscious sedation and ICE guidance. There was a significant reduction in the overall procedure time, fluoroscopy time, and time for transseptal puncture to ICE in LA. There was no difference in the size of the acute residual interatrial shunt, as measured via ICE, or the size and presence of iatrogenic ASD at follow-up. CONCLUSION Balloon dilation of TSP is safe and is associated with increased efficiency in ICE-guided LAAO procedures.
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Affiliation(s)
- Sandeep K Goyal
- Division of Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Ashish A Bhimani
- Division of Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Danesh K Kella
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Anahita Tyagi
- Division of Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | | | - Thomas F Deering
- Division of Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
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Yang S, Li S, Li S, Liao Q, Long D, Li M, He C. Intracardiac echocardiography-guided catheter ablation of highly symptomatic accelerated idioventricular rhythm originating from the right ventricular apical diverticulum. Pacing Clin Electrophysiol 2024. [PMID: 38501848 DOI: 10.1111/pace.14966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/17/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
Ventricular diverticula are saccule-like structures formed by the protrusion of the ventricular myocardium from the endocardial surface towards the free wall. Most diverticula are muscular structures, and patients usually have no obvious clinical symptoms. However, diverticula may contribute to arrhythmogenesis due to localized myocardial structural disturbances. Right ventricular apical diverticulum (RVAD) is very rare, and we report a case of highly symptomatic accelerated idioventricular rhythm (AIVR) originating from the RVAD that underwent intracardiac echocardiography (ICE)-guided catheter ablation with no recurrence during follow-up.
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Affiliation(s)
- Sen Yang
- Department of Cardiology, Yan'an Hospital, Kunming Medical University, Kunming, China
| | - Sui Li
- Department of Cardiology, Yan'an Hospital, Kunming Medical University, Kunming, China
| | - Shaolong Li
- Department of Cardiology, Yan'an Hospital, Kunming Medical University, Kunming, China
| | - Qiwei Liao
- Department of Cardiology, Yan'an Hospital, Kunming Medical University, Kunming, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chengde He
- Department of Cardiology, Yan'an Hospital, Kunming Medical University, Kunming, China
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Cheng H, Bangash AB, Tao Y, Jiang R, Liu Q, Cheng C, Fu G, Jiang C. Intracardiac echocardiography guided electrified J-wire trans-septal puncture: A prospective randomized controlled trial. Pacing Clin Electrophysiol 2024; 47:448-454. [PMID: 38291877 DOI: 10.1111/pace.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Application of electrocautery to a J-wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique. METHODS Two hundred consecutive patients were randomized in a 1:1 fashion to either the ICE-guided electrified J-wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20 W, "coag" mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time. RESULTS All patients complete the procedure safely. The electrified J-wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra-atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the two groups (3/32 patients in the J-wire TSP group and 2/26 patients in conventional BRK TSP group, p = .82). And no difference in the incidence of residual intra-atrial shunt (4.3% vs. 6%, p = .654) during the 3-month's follow up. CONCLUSION Using an electrified J-wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non-fluoroscopy AF ablation.
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Affiliation(s)
- Hui Cheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Abdul Basit Bangash
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Yuhang Tao
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Cheng Cheng
- Department of Cardiology, The Second Hospital of Anhui Medical University, HeFei, Anhui, P. R. China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, Zhejiang, P. R. China
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Pastormerlo LE, De Caterina AR, Esposito A, Korsholm K, Berti S. State-of-the-Art of Transcatheter Left Atrial Appendage Occlusion. J Clin Med 2024; 13:939. [PMID: 38398253 PMCID: PMC10889674 DOI: 10.3390/jcm13040939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Left atrial appendage occlusion (LAAO) is an increasingly used alternative to oral anticoagulation in patients with atrial fibrillation, especially in patients with absolute/relative contraindications to these therapies. This review will cover three main aspects of the procedure. In the fist part of the manuscript, we focus on patient selection. We describe three main categories of patients with primary indication to LAAO, namely patients with previous or at a high risk of intracerebral bleeding, patients with a history of major gastrointestinal bleeding and patients with end-stage renal disease and absolute contraindication to novel oral anticoagulants. Some other potential indications are also described. In the second part of the manuscript, we review available devices, trying to highlight different aspects and potential specific advantages. The last section overviews different ways for pre-, intra- and postprocedural imaging, in order to improve procedural safety and efficacy and ameliorate patient outcome. The characteristics of available contemporary devices and the role of imaging in procedural planning, intraprocedural guidance and follow-up are described.
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Affiliation(s)
- Luigi Emilio Pastormerlo
- UOC Diagnostica Interventistica Fondazione Toscana Gabriele Monasterio Massa, 54100 Massa, Italy
| | | | - Augusto Esposito
- UOC Diagnostica Interventistica Fondazione Toscana Gabriele Monasterio Massa, 54100 Massa, Italy
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, C319, 8200 Aarhus, Denmark
| | - Sergio Berti
- UOC Diagnostica Interventistica Fondazione Toscana Gabriele Monasterio Massa, 54100 Massa, Italy
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14
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Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, Paolucci M, Mazzone P, Guarracini F. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics (Basel) 2024; 14:182. [PMID: 38248058 PMCID: PMC10814721 DOI: 10.3390/diagnostics14020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Eleonora Bonvicini
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Elena Coradello
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Carbonaro
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Giulia Colombo
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Paolucci
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
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15
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De Cillis E, Acquaviva T, Ursi R, Soldato N, Basile P, Siena P, Carella MC, Baggiano A, Mushtaq S, Fusini L, Rabbat MG, Pontone G, Bottio T, Bortone AS, Ciccone MM, Milano AD, Guaricci AI. A comparison of intracardiac echocardiography and transesophageal echocardiography for guiding device closure of ostium secundum atrial septal defect: A 15-year experience. Echocardiography 2024; 41:e15724. [PMID: 38064288 DOI: 10.1111/echo.15724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/03/2023] [Accepted: 11/19/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND AIM Our aim was to evaluate the fluoroscopy time (FT), procedure time (PT) safety and efficacy when using intracardiac echocardiography (ICE) in comparison to transesophageal echocardiography (TEE) guidance for transcatheter closure of Ostium Secundum Atrial Septal Defect (OS-ASD). METHOD Ninety patients (n = 90) diagnosed with OS-ASD underwent transcatheter closure between March 2006 and October 2021. Fifty-seven patients were treated under ICE guidance, while 33 patients were treated under TEE guidance. RESULTS Mean age was 43 ± 15 years and 42 ± 10 years in the ICE and TEE groups, respectively. The majority of patients had a centrally placed defect. Median FT was 8.40 min versus 11.70 min (p < .001) in the ICE group compared to the TEE group, respectively. Median PT was 43 min versus 94 min (p < .001) in the ICE group compared to the TEE group, respectively. Both ICE and TEE provided high quality images. All interventions were completed successfully, except for one patient in the ICE group who experienced a device migration, the development of atrial tachycardia in one patient and atrial fibrillation in two patients in the ICE group which spontaneously cardioverted. There were no other complications. CONCLUSION This study on a consistent cohort of patients with OS-ASD undergoing percutaneous closure suggests that use of ICE is safe and efficacious. Compared to TEE, ICE demonstrated significantly shorter FT and PT, decreasing the entire duration of the procedure and x-ray exposure. No relevant differences were observed in terms of success rate and complications.
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Affiliation(s)
- Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Tommaso Acquaviva
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Raffaella Ursi
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Nicolò Soldato
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Basile
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Paola Siena
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, Illinois, USA
- Division of Cardiology, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Tomaso Bottio
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Marco Matteo Ciccone
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Aldo Domenico Milano
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
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16
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Diaz JC, Bastidas O, Duque M, Marín JE, Aristizabal J, Niño CD, Hoyos C, Matos CD, Gabr M, Steiger NA, Kapur S, Sauer WH, Romero JE. Impact of intracardiac echocardiography versus transesophageal echocardiography guidance on left atrial appendage occlusion procedures: A meta-analysis. J Cardiovasc Electrophysiol 2024; 35:44-57. [PMID: 37927196 DOI: 10.1111/jce.16118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is increasingly used during left atrial appendage occlusion (LAAO) as an alternative to transesophageal echocardiography (TEE). The objective of this study is to evaluate the impact of ICE versus TEE guidance during LAAO on procedural characteristics and acute outcomes, as well the presence of peri-device leaks and residual septal defects during follow-up. METHODS All studies comparing ICE-guided versus TEE-guided LAAO were identified. The primary outcomes were procedural efficacy and occurrence of procedure-related complications. Secondary outcomes included lab efficiency (defined as a reduction in in-room time), procedural time, fluoroscopy time, and presence of peri-device leaks and residual interatrial septal defects (IASD) during follow-up. RESULTS Twelve studies (n = 5637) were included. There were no differences in procedural success (98.3% vs. 97.8%; OR 0.73, 95% CI 0.42-1.27, p = .27; I2 = 0%) or adverse events (4.5% vs. 4.4%; OR 0.81 95% CI 0.56-1.16, p = .25; I2 = 0%) between the ICE-guided and TEE-guided groups. ICE guidance reduced in in-room time (mean-weighted 28.6-min reduction in in-room time) without differences in procedural time or fluoroscopy time. There were no differences in peri-device leak (OR 0.93, 95% CI 0.68-1.27, p = 0.64); however, an increased prevalence of residual IASD was observed with ICE-guided versus TEE-guided LAAO (46.3% vs. 34.2%; OR 2.23, 95% CI 1.05-4.75, p = 0.04). CONCLUSION ICE guidance is associated with similar procedural efficacy and safety, but could result in improved lab efficiency (as established by a significant reduction in in-room time). No differences in the rate of periprocedural leaks were found. A higher prevalence of residual interatrial septal defects was observed with ICE guidance.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Universidad CES Medical School, Division of Cardiology, Clinica Las Vegas, Medellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Mauricio Duque
- Cardiac Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Jorge E Marín
- Department of Medicine, Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Americas, Medellin, colombia, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Cesar D Niño
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed Gabr
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Rauber M, Manninger M, Eberl AS, Scherr D. Zero-fluoroscopy ablation with multielectrode pulse field ablation system: Case series. Pacing Clin Electrophysiol 2024; 47:117-120. [PMID: 37885274 DOI: 10.1111/pace.14860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/25/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Abstract
Pulse field ablation (PFA) is a novel nonthermal ablation modality for treatment of atrial fibrillation. While mostly lacking 3D electroanatomical mapping integration, reported radiation doses in procedures using multielectrode PFA catheters are relatively high. We report a first case series of three patients where a zero-fluoroscopy approach by intracardiac echocardiography was utilized and present a possible workflow for zero-fluoroscopy ablation with the Farapulse PFA system.
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Affiliation(s)
- Martin Rauber
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Martin Manninger
- Department of Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Anna-Sophie Eberl
- Department of Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Department of Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
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Blusztein D, Sarwary S, Parikh DS, Garcia S, Price MJ, Nayak K, Aragon J, Mahadevan VS. Safety of Same-Day Hospital Discharge Post Patent Foramen Ovale Closure: Findings from a Multicenter Study. Am J Cardiol 2023; 208:118-123. [PMID: 37832208 DOI: 10.1016/j.amjcard.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/15/2023]
Abstract
Transcatheter patent foramen ovale (PFO) closure is indicated for patients with cryptogenic stroke. Although procedural safety is well established, there are limited data on the safety of same-day (SD) discharge. We aimed to review the outcomes of PFO closure with SD. Patients who underwent transcatheter PFO closure between January 2011 and May 2022 at 4 large US hospitals were retrospectively analyzed, comparing outcomes of SD versus delayed discharge (DD). The primary end point was a composite of access-site complication, stroke, device embolization, atrial arrhythmia, and bleeding. Secondary analysis comparing imaging modality and outcomes was performed. 554 patients (49.2% female) were analyzed (382 discharged SD). Average age was 54.3 ± 15. Baseline characteristics in both groups were broadly similar. Previous stroke (78.0% SD vs 76.2% DD, p = 0.32) was the commonest indication for PFO closure. In the SD group, there was less general anesthesia use (5.5% vs 16.9%, p <0.001). Intraprocedural intracardiac echocardiography was used more frequently in SD cases (95.0% vs 81.4%, p <0.001). In the DD group, median stay was 1 night, and 34.9% stayed beyond 1 night. At 30 days, there was no difference in the primary composite end point (14.9% vs 11.6%, p = 0.15). There was no inter-group difference in individual adverse events (all p >0.05). When comparing imaging modality and outcomes, there was no difference in composite end points between transesophageal and intracardiac echocardiography (6.5% vs 14.7%, p = 0.063). In conclusion, SD discharge after transcatheter PFO closure appears safe. This efficient approach may be advantageous in optimizing workflow and minimizing hospital occupancy.
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Affiliation(s)
- David Blusztein
- Department of Cardiology, University of California, San Francisco, California.
| | - Shabir Sarwary
- Department of Cardiology, University of California, San Francisco, California
| | - Devang S Parikh
- Department of Cardiology, University of California, San Francisco, California
| | - Santiago Garcia
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Matthew J Price
- Department of Cardiology, Scripps Clinic, San Diego, California
| | - Keshav Nayak
- Department of Cardiology, Scripps Clinic, San Diego, California
| | - Joseph Aragon
- Department of Cardiology, Santa Barbara Cottage Hospital, Santa Barba, California
| | - Vaikom S Mahadevan
- Department of Cardiology, University of California, San Francisco, California
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Ferro EG, Alkhouli M, Nair DG, Kapadia SR, Hsu JC, Gibson DN, Freeman JV, Price MJ, Roy K, Allocco DJ, Yeh RW, Piccini JP. Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S. JACC Clin Electrophysiol 2023; 9:2587-2599. [PMID: 37831030 DOI: 10.1016/j.jacep.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/25/2023] [Accepted: 08/03/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Intraprocedural imaging is critical for device delivery in transcatheter left atrial appendage occlusion (LAAO). Although pivotal trials of LAAO devices were conducted using transesophageal echocardiography (TEE), intracardiac echocardiography (ICE) is an emerging imaging modality. OBJECTIVES This study compared outcomes after ICE- and TEE-guided Watchman FLX implantation in the SURPASS (SURveillance Post Approval AnalySiS Plan) nationwide LAAO registry. METHODS Baseline characteristics were compared using chi-square and t-tests. Outcomes were reported in unadjusted and adjusted comparisons via propensity weighting. RESULTS Between August 2020 and September 2021, LAAO was attempted in 39,759 patients at 698 sites, including 2,272 cases (5.7%) with ICE and 31,835 (80.0%) with TEE. ICE and TEE patients had similar baseline characteristics and mean procedural times (ICE 82 minutes vs TEE 78 minutes). ICE patients were less likely to receive general anesthesia (54% vs 98%, P < 0.01). Successful device implantation (98.3% vs 97.6%) and complete seal rates at 45 days were similar (n = 25,280; 83% vs 82%). Most adverse event rates were similar; unadjusted mortality rates at 45 days were 1.1% for ICE vs 0.8% for TEE (P = 0.14), and 1.0% vs 0.7% (P = 0.27) in adjusted analyses. Even after adjustment, pericardial effusion rates requiring intervention were significantly higher with ICE at 45 days (1.0% vs 0.5%; P = 0.02). This rate decreased as operators performed more ICE-guided procedures, although 82% of operators had performed <10 ICE-guided procedures overall. CONCLUSIONS In the largest comparison to date, ICE use was infrequent. ICE and TEE both achieved high rates of complete LAAO. ICE was associated with significantly higher rates of pericardial effusion requiring intervention.
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Affiliation(s)
- Enrico G Ferro
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Devi G Nair
- St Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan C Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, California, USA
| | - Douglas N Gibson
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
| | - Kristine Roy
- Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | | | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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20
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Ding X, Xiang K, Qian C, Hou X, Wu F. Intracardiac echocardiography is a promising strategy for guiding closure of the left atrial appendage. Health Sci Rep 2023; 6:e1762. [PMID: 38116174 PMCID: PMC10728371 DOI: 10.1002/hsr2.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Background and Aims Percutaneous transcatheter left atrial appendage (LAA) closure (LAAC) is an effective approach for preventing ischemic stroke in nonvalvular atrial fibrillation patients. Intracardiac echocardiography (ICE), a new imaging modality, is a promising strategy for guiding LAAC. This review highlights the various strategies for ICE-guided-LAAC as an option for clinical policy. Methods A comprehensive literature search was conducted of PubMed, ScienceDirect, Ovid Web of Science, SpringerLink, and other notable databases to identify recent peer-reviewed clinical trials, reviews, and research articles related to ICE and its application in the guidance of LAAC. Results Various methods are used to evaluate the spatial structure and dimensions of the LAA. The main techniques for guiding LAAC are transesophageal echocardiography (TEE), cardiac computed tomography (CTA), and ICE. Among these techniques, the advantages of ICE typically include (1) multiangle and real-time assessment of intracardiac structure, (2) a reduction in procedural fluoroscopy, (3) reduced operation time and improved workflow in the catheterization laboratory, and (4) the avoidance of general anesthesia and the early detection of complications. Conclusion ICE is a promising strategy for the guidance of LAAC. Among the most advanced and recent technological innovations in cardiovascular imaging in general and volume imaging in particular, ICE offers greater efficacy and safety.
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Affiliation(s)
- Xueyan Ding
- Department of CardiologySir Run Run Shaw Hospital Zhejiang University School of MedicineHangzhouZhejiangP.R. China
| | - Kefa Xiang
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
| | - Congli Qian
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
| | - Xu Hou
- Bengbu Medical CollegeBengbuAnhuiP.R. China
| | - Feng Wu
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
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DeLurgio DB. Intracardiac Echo for Left Atrial Appendage Closure: Will Practice Make Perfect? JACC Clin Electrophysiol 2023; 9:2600-2602. [PMID: 38151304 DOI: 10.1016/j.jacep.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 12/29/2023]
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Ho EC, Assafin M, Sugiura T, Granada JF, Chau M, Latib A. 3-dimensional intracardiac echocardiography for structural heart interventions. Front Cardiovasc Med 2023; 10:1180299. [PMID: 38045907 PMCID: PMC10690929 DOI: 10.3389/fcvm.2023.1180299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/25/2023] [Indexed: 12/05/2023] Open
Abstract
New generation 3-dimensional matrix array intracardiac echocardiography catheters have become commercially available recently, increasing image plane options compared to 2-dimensional and older generation 3-dimensional intracardiac echocardiography catheters. They are beginning to play an important role in structural heart interventions, especially for transcatheter tricuspid interventions, due to advantages in some situations that increase image quality over transesophageal echocardiography.
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Affiliation(s)
- Edwin C. Ho
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Manaf Assafin
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Tadahisa Sugiura
- Division of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Juan F. Granada
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
- Cardiovascular Research Foundation, New York, NY, United States
| | - Mei Chau
- Division of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
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Shang X, Sun M, Wang Z, Jin Z, Liang M. Comparison of intracardiac vs. transesophageal echocardiography for "one-stop" procedures of combined radiofrequency catheter ablation and left atrial appendage closure with the Watchman device in the treatment of atrial fibrillation. Front Cardiovasc Med 2023; 10:1265550. [PMID: 38028460 PMCID: PMC10666739 DOI: 10.3389/fcvm.2023.1265550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective This study aimed to assess the efficacy and safety of "one-stop" procedures that combined radiofrequency catheter ablation and left atrial appendage closure (LAAC) with the Watchman device under the guidance of intracardiac echocardiography (ICE) vs. transesophageal echocardiography (TEE) in patients with atrial fibrillation. Methods and results In this study, we prospectively enrolled patients who underwent "one-stop" procedures under the guidance of ICE (n = 193, 109 men, 65.02 ± 8.47 years) or TEE (n = 109, 69 men, 64.23 ± 7.75 years) between January 2021 and October 2022. Intraprocedural thrombus formation in the left atrial appendage (LAA) was observed in 3 (1.46%) patients in the ICE group and 15 (11.63%) patients in the TEE group (P < 0.05) before LAAC. Total fluoroscopy time and dose in the ICE group were less than those in the TEE group. The total "one-stop" turnaround time and LAAC procedure time in the ICE group were significantly shorter than those in the TEE group (P < 0.05). Postoperative esophagus discomfort, nausea and vomiting, and hypotension were more often seen in the TEE group (P < 0.001). There was no significant difference in matched cases between ICE and fluoroscopy measurements (P = 0.082). The TEE results related to LAAC and clinical events were similar between the two groups during the follow-up (P > 0.05). Conclusion The ICE-guided "one-stop" procedure was safe and feasible with less radiation exposure, shorter turnaround time, and fewer complications and intraoperative thrombus formations than the TEE group. ICE offered accurate measurements in the LAA dimension during LAAC. Echocardiography during the "one-stop" procedures was necessary to rule out the intraoperative thrombus.
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Affiliation(s)
- Xining Shang
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command of China Medical University, Shenyang, China
| | - Mingyu Sun
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zulu Wang
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiqing Jin
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Liang
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
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Debreceni D, Janosi KF, Turcsan M, Toth D, Bocz B, Simor T, Kupo P. Feasibility and safety of cavotricuspid isthmus ablation using exclusive intracardiac echocardiography guidance: a proof-of-concept, observational trial. Front Cardiovasc Med 2023; 10:1244137. [PMID: 37900565 PMCID: PMC10601457 DOI: 10.3389/fcvm.2023.1244137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Catheter ablation is the preferred treatment for typical atrial flutter (AFl), but it can be challenging due to anatomical abnormalities. The use of 3D electroanatomical mapping systems (EAMS) has reduced fluoroscopy exposure during AFl ablation. Intracardiac echocardiography (ICE) has also shown benefits in reducing radiation exposure during AFl ablation. However, there is a lack of evidence on the feasibility of ICE-guided, zero-fluoroscopy AFl ablation without the use of EAMS. Methods In this prospective study, we enrolled 80 patients with CTI-dependent AFl. The first 40 patients underwent standard fluoroscopy + ICE-guided ablation (Standard ICE group), while the other 40 patients underwent zero-fluoroscopy ablation using only ICE (Zero ICE group). Procedure outcomes, including acute success, procedure time, fluoroscopy time, radiation dose, and complications, were compared between the groups. Results The acute success rate was 100% in both groups. Out of the 40 cases, the zero-fluoroscopy strategy was successfully implemented in 39 cases (97.5%) in the Zero ICE group. There were no significant differences in procedure time [55.5 (46.5; 66.8) min vs. 51.5 (44.0; 65.5), p = 0.50] and puncture to first ablation time [18 (13.5; 23) min vs. 19 (15; 23.5) min, p = 0.50] between the groups. The Zero ICE group had significantly lower fluoroscopy time [57 (36.3; 90) sec vs. 0 (0; 0) sec, p < 0.001] and dose [3.17 (2.27; 5.63) mGy vs. 0 (0; 0) mGy, p < 0.001] compared to the Standard ICE group. Total ablation time was longer in the Standard ICE group [597 (447; 908) sec vs. 430 (260; 750), p = 0.02], but total ablation energy [22,458 (14,836; 31,116) Ws vs. 17,043 (10,533; 29,302) Ws, p = 0.10] did not differ significantly. First-pass bidirectional conduction block of the CTI and acute reconnection rates were similar between the groups. No complications or recurrences were observed during the follow-up period. Conclusion Our study suggests that zero-fluoroscopy CTI ablation guided solely by ICE for AFl is feasible and safe. Further investigation is warranted for broader validation.
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Affiliation(s)
| | | | | | | | | | | | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
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25
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Pongratz J, Kuniss M, Wu L, Tebbenjohanns J, Nölker G, Dorwarth U, Kuck KH, Jochen S, Hoffmann E, Straube F. Impact of intracardiac echocardiography usage on the safety of cryoballoon atrial fibrillation ablation: Subanalysis of the prospective FREEZE cluster cohort study. J Cardiovasc Electrophysiol 2023; 34:2029-2039. [PMID: 37681996 DOI: 10.1111/jce.16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Cryoballoon ablation (CBA) aiming at pulmonary vein isolation (PVI) became a standardized atrial fibrillation (AF) ablation procedure. Life-threatening complications like cardiac tamponade exist. Intracardiac echocardiography (ICE) usage is associated with superior safety in radiofrequency ablation. It is unclear if ICE has an impact on safety of CBA. METHODS The FREEZE Cohort (NCT01360008) subanalysis included patients undergoing "PVI only" CBA. Patients with intraprocedural transesophageal echocardiography were excluded. Group A comprises conventional, group B ICE-guided CBA. Periprocedural results were compared. RESULTS From 2011 to 2016, a total of 4189 patients were enrolled, and 1906 (45.5%) were included in this subanalysis, split up in two groups (A: 1066 [55.9%], B: 840 [44.1%]). Group A was younger (60.6 ± 10.8 vs. 62.4 ± 10.5 years, p < .001), with smaller left atria (41 vs. 43 mm, p < .001), and less persistent AF (23.1 vs. 38.1%, p < .001). Procedure, left atrial, and fluoroscopy times were shorter in group A as compared to group B. Dose area product was significantly higher in group A (2911 vs. 2072 cGyxcm2 , p < .001). In-hospital major adverse cerebrovascular and cardiac event rates including two deaths in group A were not different between groups (0.5% vs. 0.1%, p = .18). The rate of total procedural (10.4% vs. 5.1%, p < .001) and major complications (3.2% vs. 1.3%, p < .001) was significantly higher in group A. Cardiac tamponade occurred significantly more frequently in group A (8 [0.8%] vs. 1 [0.1%], p = .046). Independent predictors for major complications were female sex (odds ratio [OR] 2.03, p = .03) and non-ICE usage (OR 2.38, p = .02). No differences were observed for persistent phrenic nerve palsy, nor for groin complications. CONCLUSION CBA was significantly safer and required less radiation if ICE was used, although the procedures were more complex. The risk of groin complications was not increased with ICE usage. Non-ICE usage was the only modifiable independent predictor of major complications.
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Affiliation(s)
- Janis Pongratz
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, München, Bavaria, Germany
| | - Malte Kuniss
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim, Germany
| | - Liqun Wu
- Department of Cardiology, Shanghai Rui Jin Hospital, Shanghai, People's Republic of China
| | | | - Georg Nölker
- Innere Klinik II/Kardiologie, Christliches Klinikum Unna-Mitte, Unna, Germany
| | - Uwe Dorwarth
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, München, Bavaria, Germany
| | - Karl-Heinz Kuck
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | - Ellen Hoffmann
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, München, Bavaria, Germany
| | - Florian Straube
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, München, Bavaria, Germany
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26
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Turcsan M, Janosi KF, Debreceni D, Toth D, Bocz B, Simor T, Kupo P. Intracardiac Echocardiography Guidance Improves Procedural Outcomes in Patients Undergoing Cavotricuspidal Isthmus Ablation for Typical Atrial Flutter. J Clin Med 2023; 12:6277. [PMID: 37834921 PMCID: PMC10573340 DOI: 10.3390/jcm12196277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Atrial flutter (AFL) represents a prevalent variant of supraventricular tachycardia, distinguished by a macro-reentrant pathway encompassing the cavotricuspid isthmus (CTI). Radiofrequency (RF) catheter ablation stands as the favored therapeutic modality for managing recurring CTI-dependent AFL. Intracardiac echocardiography (ICE) has been proposed as a method to reduce radiation exposure during CTI ablation. This study aims to comprehensively compare procedural parameters between ICE-guided CTI ablation and fluoroscopy-only procedures. A total of 370 consecutive patients were enrolled in our single-center retrospective study. In 151 patients, procedures were performed using fluoroscopy guidance only, while 219 patients underwent ICE-guided CTI ablation. ICE guidance significantly reduced fluoroscopy time (73 (36; 175) s vs. 900 (566; 1179) s; p < 0.001), fluoroscopy dose (2.45 (0.6; 5.1) mGy vs. 40.5 (25.7; 62.9) mGy; p < 0.001), and total procedure time (70 (52; 90) min vs. 87.5 (60; 102.5) min; p < 0.001). Total ablation time (657 (412; 981) s vs. 910 (616; 1367) s; p < 0.001) and the time from the first to last ablation (20 (11; 36) min vs. 40 (25; 55) min; p < 0.01) were also significantly shorter in the ICE-guided group. Acute success rate was 100% in both groups, and no major complications occurred in either group. ICE-guided CTI ablation in patients with AFL resulted in shorter procedure times, reduced fluoroscopy exposure, and decreased ablation times, compared to the standard fluoroscopy-only approach.
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Affiliation(s)
| | | | | | | | | | | | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Ifjusag utja 13, H-7624 Pecs, Hungary; (M.T.); (K.-F.J.); (D.D.); (D.T.); (B.B.); (T.S.)
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Jiang C, Ma C, Chen S, Chen S, Jiang C, Jiang R, Ju W, Long D, Li D, Li J, Liu Q, Ma W, Pu X, Wang R, Wang Y, Yi F, Zou C, Zhang J, Zhang X, Zhao Y, Zei PC, Biase LD, Chang D, Cai H, Chen L, Chen M, Fu G, Fu H, Fan J, Gui C, Jiang T, Liu S, Li X, Li Y, Shu M, Wang Y, Xu J, Xie R, Xia Y, Xue Y, Yang P, Yuan Y, Zhong J, Zhu W. Chinese expert consensus on the construction of the fluoroless cardiac electrophysiology laboratory and related techniques. Pacing Clin Electrophysiol 2023; 46:1035-1048. [PMID: 37573146 DOI: 10.1111/pace.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 08/14/2023]
Abstract
Transcatheter radiofrequency ablation has been widely introduced for the treatment of tachyarrhythmias. The demand for catheter ablation continues to grow rapidly as the level of recommendation for catheter ablation. Traditional catheter ablation is performed under the guidance of X-rays. X-rays can help display the heart contour and catheter position, but the radiobiological effects caused by ionizing radiation and the occupational injuries worn caused by medical staff wearing heavy protective equipment cannot be ignored. Three-dimensional mapping system and intracardiac echocardiography can provide detailed anatomical and electrical information during cardiac electrophysiological study and ablation procedure, and can also greatly reduce or avoid the use of X-rays. In recent years, fluoroless catheter ablation technique has been well demonstrated for most arrhythmic diseases. Several centers have reported performing procedures in a purposefully designed fluoroless electrophysiology catheterization laboratory (EP Lab) without fixed digital subtraction angiography equipment. In view of the lack of relevant standardized configurations and operating procedures, this expert task force has written this consensus statement in combination with relevant research and experience from China and abroad, with the aim of providing guidance for hospitals (institutions) and physicians intending to build a fluoroless cardiac EP Lab, implement relevant technologies, promote the standardized construction of the fluoroless cardiac EP Lab.
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Affiliation(s)
- Chenyang Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songwen Chen
- Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shiquan Chen
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenxi Jiang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruhong Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weizhu Ju
- Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Deyong Long
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ding Li
- Peking University People's Hospital, Beijing, China
| | - Jia Li
- The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qiang Liu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Ma
- Tianjin Chest Hospital, Tianjin, China
| | - Xiaobo Pu
- West China Hospital, Sichuan University, Chengdu, China
| | - Rui Wang
- First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuegang Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fu Yi
- Xijing Hospital, The First Affiliated Hospital of Air Force Medical University, Xian, China
| | - Cao Zou
- The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Jidong Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xi Zhang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Yujie Zhao
- The seventh People's Hospital of Zhenzhou, Zhengzhou, China
| | - Paul C Zei
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Dong Chang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Heng Cai
- Tianjin Medical University General Hospital, Tianjin, China
| | | | - Minglong Chen
- Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guosheng Fu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Fu
- West China Hospital, Sichuan University, Chengdu, China
| | - Jie Fan
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Chun Gui
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tingbo Jiang
- The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Shaowen Liu
- Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xuebin Li
- Peking University People's Hospital, Beijing, China
| | - Yigang Li
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Maoqin Shu
- Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yan Wang
- Tongji Hospital, Tongji Medical College of HUST, Wuhan, China
| | - Jian Xu
- The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei, China
| | - Ruiqin Xie
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunlong Xia
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yumei Xue
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Pingzhen Yang
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yiqiang Yuan
- Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jingquan Zhong
- Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenqing Zhu
- Zhongshan Hospital, Fudan University, Shanghai, China
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Bocz B, Debreceni D, Janosi KF, Turcsan M, Simor T, Kupo P. Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial. J Clin Med 2023; 12:5577. [PMID: 37685645 PMCID: PMC10488800 DOI: 10.3390/jcm12175577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective study, we aimed to compare the effectiveness of an electroanatomical mapping system (EAMS)-guided approach with an ICE-guided approach for SP ablation. Eighty patients undergoing SP ablation for AVNRT were randomly assigned to either the ICE-guided or EAMS-guided group. If the procedural endpoint was not achieved after 8 RF applications; patients were allowed to crossover to the ICE-guided group. The ICE-guided approach reduced the total procedure time (61.0 (56.0; 66.8) min vs. 71.5 (61.0; 80.8) min, p < 0.01). However, the total fluoroscopy time was shorter (0 (0-0) s vs. 83.5 (58.5-133.25) s, p < 0.001) and the radiation dose was lower (0 (0-0) mGy vs. 3.3 (2.0-4.7) mGy, p < 0.001) with EAMS-guidance. The ICE-guided group had a lower number of RF applications (4 (3-5) vs. 5 (3.0-7.8), p = 0.03) and total ablation time (98.5 (66.8-186) s vs. 136.5 (100.5-215.8) s, p = 0.02). Nine out of 40 patients (22.5%) in the EAMS-guided group crossed over to the ICE-guided group, and they were successfully treated with similar RF applications in terms of number, time, and energy compared to the ICE-guided group. There were no recurrences during the follow-up period. In conclusion, the utilization of ICE guidance during SP ablation has demonstrated notable reductions in procedural time and RF delivery when compared to procedures guided by EAMS. In challenging cases, an early switch to ICE-guided ablation may be the optimal choice for achieving successful treatment.
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Affiliation(s)
| | | | | | | | | | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Ifjusag Utja 13, H-7624 Pécs, Hungary; (B.B.); (D.D.); (K.-F.J.); (M.T.); (T.S.)
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Laterra G, Dattilo G, Correale M, Brunetti ND, Artale C, Sacchetta G, Pistelli L, Borgi M, Campanella F, Cocuzza F, Lo Nigro MC, Contarini M. Imaging Modality to Guide Left Atrial Appendage Closure: Current Status and Future Perspectives. J Clin Med 2023; 12:jcm12113756. [PMID: 37297950 DOI: 10.3390/jcm12113756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/30/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. The left atrial appendage (LAA) is the most likely source of thrombus formation in patients with non-valvular atrial fibrillation (NVAF). Left atrial appendage closure (LAAC) represents an effective alternative to NOAC in patients with NVAF. Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) in addition to standard fluoroscopy to guide LAAC. TEE-guided LAAC usually requires general anesthesia. The ICE technique is a "minimalist approach", without general anesthesia, but ICE imaging techniques are not yet simplified and standardize, and the ICE may result in inferior image quality compared with that of TEE. Another "minimalist approach" can be the use of ICE via the esophageal route (ICE-TEE), that jet is validated to identify the presence of LAA thrombi in patients and to perform other procedures. In our cath laboratory ICE-TEE to guide LAAC is used in some complex patients. Indeed, our single center experience suggests that ICE-TEE could be a good alternative imaging technique to guide LAAC procedure without general anesthesia.
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Affiliation(s)
- Giulia Laterra
- Cardiology Unit, Department of Emergency, Umberto Primo Hospital, 94100 Enna, Italy
| | - Giuseppe Dattilo
- Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Michele Correale
- Cardiothoracic Department, Policlinico Riuniti University Hospital, 71122 Foggia, Italy
| | | | - Claudia Artale
- Cardiology Unit, Department of Emergency, Umberto Primo Hospital, 96100 Siracusa, Italy
| | - Giorgio Sacchetta
- Cardiology Unit, Department of Emergency, Umberto Primo Hospital, 96100 Siracusa, Italy
| | - Lorenzo Pistelli
- Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Marco Borgi
- Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Francesca Campanella
- Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Federica Cocuzza
- Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Maria Claudia Lo Nigro
- Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Marco Contarini
- Cardiology Unit, Department of Emergency, Umberto Primo Hospital, 96100 Siracusa, Italy
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Zhang ZY, Li F, Zhang J, Zhang L, Liu HH, Zhao N, Yang F, Kong Q, Zhou YT, Qian LL, Wang RX. A comparable efficacy and safety between intracardiac echocardiography and transesophageal echocardiography for percutaneous left atrial appendage occlusion. Front Cardiovasc Med 2023; 10:1194771. [PMID: 37293288 PMCID: PMC10244765 DOI: 10.3389/fcvm.2023.1194771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Background Accumulated clinical studies utilized intracardiac echocardiography (ICE) to guide percutaneous left atrial appendage occlusion (LAAO). However, its procedural success and safety compared to traditional transesophageal echocardiography (TEE) remained elusive. Therefore, we performed a meta-analysis to compare efficacy and safety of ICE and TEE for LAAO. Methods We screened studies from four online databases (including the Cochrane Library, Embase, PubMed, and Web of Science) from their inception to 1 December 2022. We used a random or fixed-effect model to synthesize the clinical outcomes and conducted a subgroup analysis to identify the potential confounding factors. Results A total of twenty eligible studies with 3,610 atrial fibrillation (AF) patients (1,564 patients for ICE and 2,046 patients for TEE) were enrolled. Compared with TEE group, there was no significant difference in procedural success rate [risk ratio (RR) = 1.01; P = 0.171], total procedural time [weighted mean difference (WMD) = -5.58; P = 0.292], contrast volume (WMD = -2.61; P = 0.595), fluoroscopic time (WMD = -0.34; P = 0.705; I2 = 82.80%), procedural complications (RR = 0.82; P = 0.261), and long-term adverse events (RR = 0.86; P = 0.329) in the ICE group. Subgroup analysis revealed that ICE group might be associated with the reduction of contrast use and fluoroscopic time in the hypertension proportion <90 subgroup, with lower total procedure time, contrast volume, and the fluoroscopic time in device type subgroup with multi-seal mechanism, and with the lower contrast use in paroxysmal AF (PAF) proportion ≤50 subgroup. Whereas, ICE group might increase the total procedure time in PAF proportion >50 subgroup and contrast use in multi-center subgroup, respectively. Conclusion Our study suggests that ICE may have comparable efficacy and safety compared to TEE for LAAO.
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Ho CB, Vejlstrup NG, De Backer O, Søndergaard L. Intracardiac echocardiogram to diagnose infective endocarditis after transcatheter aortic valve-in-valve implantation. Catheter Cardiovasc Interv 2023. [PMID: 37210620 DOI: 10.1002/ccd.30694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
A 70-year-old man with history of transcatheter aortic valve-in-valve implantation was admitted because of suspected infective endocarditis (IE). Transesophageal echocardiogram did not reveal any vegetations, as the metallic stent frames caused significant artifacts. Position emission tomography was also negative. Intracardiac echocardiogram (ICE) was performed retrogradely through the ascending aorta, which showed clear vegetations over the stent frame of the transcatheter heart valve. Endocarditis after transcatheter aortic valve implantation was not uncommon. With increasing use of valve-in-valve procedures, echocardiographic diagnosis of IE would be more challenging. This case demonstrated the advantage of ICE over conventional echocardiography in visualizing the neo-aortic valve complex for diagnosing IE.
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Affiliation(s)
- Cheuk Bong Ho
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels G Vejlstrup
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Baran J, Skrzyńska-Kowalczyk M, Piotrowski R, Sikorska A, Kryński T, Kułakowski P. Is catheter-tissue contact force value important for ablation of ventricular arrhythmias originating from the left ventricular papillary muscles? Front Cardiovasc Med 2023; 10:1166810. [PMID: 37273878 PMCID: PMC10235700 DOI: 10.3389/fcvm.2023.1166810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Background Good catheter-tissue contact is mandatory to create effective ablation lesions. The minimal contact force value for ablation of arrhythmias originating from the left ventricle is 8.0-10.0 grams but is not known for arrhythmias arising from papillary muscles. Purpose To analyze contact force values during successful ablation procedures of arrhythmias originating from the left ventricular papillary muscles. Methods 24 consecutive patients (mean age 57.9 ± 11.9 years, 16 males) underwent ablation of premature ventricular complexes originating from left ventricular papillary muscles with the use of CARTO electro-anatomical system and intracardiac echocardiography. Results Acute complete abolition of ventricular ectopy was obtained in 23 (96%) patients. The fluoroscopy time was 3.9 ± 3.5 min and procedure duration - 114.8 ± 37.9 min. The mean contact force during successful ablations was 3.0 ± 1.1 grams and 3.18 ± 1.8 grams for antero-lateral and postero-medial papillary muscle, respectively (NS). The mean contact force during a single unsuccessful ablation was 3.0 grams. At control Holter ECG, the mean Ectopy Burden was Reduced in the Antero-Lateral Papillary Muscle Group from 18.0% ± 7.9% to 2.6% ± 2.9% (p = 0.005415) and in the Postero-Medial Papillary Muscle Group - from 34.8% ± 13.7%-1.7% ± 1.3% (p = 0.012694). During Median 27 (IQR: 17-34) Months of Follow-up There one Recurrence of Arrhythmia. Conclusion The values of contact force for successful ablation of ventricular ectopy originating from the left ventricular papillary muscles may be much lower than those for ablation of other foci which questions the role of contact force measurement when ablating these arrhythmias.
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Affiliation(s)
- Jakub Baran
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Martyna Skrzyńska-Kowalczyk
- Department of Internal Medicine and Cardiology University Clinical Center, Medical University of Warsaw, Warsaw, Poland
| | - Roman Piotrowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Kryński
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kułakowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
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Lan Q, Wu F, Ye X, Wang S, Zhong J. Intracardiac vs. transesophageal echocardiography for guiding transcatheter closure of interatrial communications: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1082663. [PMID: 37215547 PMCID: PMC10198467 DOI: 10.3389/fcvm.2023.1082663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Background Transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) is an established practice, and it requires monitoring and guidance. Both transoesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) can be used as guidance tools. However, the use of ICE and TEE in structural heart disease is controversial and the advantages and disadvantages of both for ASD and PFO closure need to be investigated. We did a systematic review and meta-analysis to compare the efficacy and safety of TEE and ICE for guiding transcatheter closure of ASD and PFO. Methods A systematic search of Embase, PubMed, Cochrane library, Web of Science was conducted from inception to May 2022. The outcomes of this study included average time for both fluoroscopy and the procedure, complete closure, length of stay at hospital and adverse events. This study was performed using mean difference (MD), relative risk (RR) and 95% confidence interval (CI). Results The meta-analysis was conducted with a total of 11 studies, involving 4,748 patients were included in meta-analysis, including 2,386 patients in the ICE group and 2,362 patients in the TEE group. The results of the meta-analysis showed that compared with TEE, ICE was shorter in time both fluoroscopy [MD: -3.72 (95%CI: -4.09 to -3.34) minutes, P < 0.00001] and the procedure [MD: -6.43 (95%CI: -7.65 to -5.21) minutes, P < 0.00001], shorter length of stay at hospital [MD = -0.95 (95% CI = -1.21 to -0.69) days, P < 0.00001], lower incidence of adverse events (RR = 0.72, 95%CI: 0.62 to 0.84, P < 0.0001), and the arrhythmia (RR = 0.50, 95% CI = 0.27 to 0.94, P = 0.03) and vascular complications (RR = 0.52, 95%CI = 0.29 to 0.92, P = 0.02) in ICE group were lower than those in TEE group. No significant difference in complete closure was found between ICE and TEE (RR = 1.00, 95% CI = 0.98 to 1.03, P = 0.74). Conclusion Under the premise of ensuring successful rate of complete closure, ICE can shorten time between fluoroscopy and procedure and length of stay at hospital, and there was no increase in adverse events. However, more high-quality studies are needed to confirm the benefits of using ICE in ASD and PFO closure.
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Affiliation(s)
- Qingsu Lan
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fengchao Wu
- Cardiology Department, Shanxi Provincial People's Hospital, Xi'an, China
| | - Xudong Ye
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Shaohua Wang
- Clinical Medical College, Dali University, Dali, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Chen T, Chang L, Rong B, Zhang K, Fan G, Kong J, Ling M, Kong Q, Maduray K, Zhao C, Zhong J. Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias. J Clin Med 2023; 12:jcm12093154. [PMID: 37176594 PMCID: PMC10179325 DOI: 10.3390/jcm12093154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/04/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES The catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PMs) is challenging. This study sought to address whether the combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve the acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias. METHODS AND RESULTS From May 2015 to August 2022, a total of thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs were located in anterolateral PMs in 11 and posteromedial PMs in 22. A combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. A mean of 6.93 ± 4.91 for lesions was used per patient, comparable between the CFS/ICE and no ICE/CFS (4.90 ± 2.23 vs. 10.17 ± 5.89; p = 0.011). The mean CF achieved in the ICE/CFS group was 7.52 ± 3.31 g. Less X-ray time was used in the combination group (CFS/ICE: 165.67 ± 47.80 S vs. no ICE/CFS: 365.00 ± 183.73 S; p < 0.001). An acute success rate of 100% was achieved for the ICE/CFS group (n = 22) and 66.67% for the no ICE/CFS group (n = 8). VA recurrence at the 11.21 ± 7.21-month follow-up was 14.2% for the ICE/CFS group and 50% for the no ICE/CFS group (p = 0.04). No severe complications occurred in all patients. CONCLUSIONS The combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) could provide precise geometries of cardiac endocavitary structures and accurate contact information for the catheter during ablation, which improved acute and long-term ablation outcomes. The routine adoption of this strategy should be considered to improve the outcomes of LV PM VA ablation.
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Affiliation(s)
- Tongshuai Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Lujie Chang
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Bing Rong
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kai Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Guanqi Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jing Kong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Mingying Ling
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qingyu Kong
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kellina Maduray
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Cuifen Zhao
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Jinan 250012, China
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Ma W, Qiu J, Lu F, Michael Shehata, Wang X, He L, Zhang F, Fan S, Zhang E, Wu D, Wang Z, Xu J. Catheter ablation of idiopathic left fascicular ventricular tachycardia: Implications of false tendons for mapping and ablation. J Cardiovasc Electrophysiol 2023; 34:673-681. [PMID: 36651353 DOI: 10.1111/jce.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The anatomical substrate for idiopathic left ventricular tachycardia (ILVT) remains speculative. Purkinje networks surrounding false tendons (FTs) might be involved in the reentrant circuit of ILVT. The objective was to evaluate the anatomical and electrophysiological features of false tendons FTs in relation to ILVT. METHODS Intracardiac echocardiography (ICE) was conducted on patients with ILVT. The relationship of the FTs with ILVT was determined using electro-anatomical mapping. RESULTS Electrophysiological evaluation and radiofrequency ablation were conducted in 23 consecutive patients with ILVT. FTs were identified in 19/23 cases (82.6%) with P1 potentials during VT recorded at the FT in 14 of these patients (73.7%). Three FT types were identified. In type 1, the FT attached the septum to the base of the posteromedial papillary muscle (PPM) (4/19); type 2 FTs ran between the septum and the PPM apex (3/19), while in type 3, the connection occurred between the septum and apex (11/19) or between the septum and the LV free wall (1/19). The effective ILVT ablation sites were situated at the FT-PPM (3/19) and the FT-septum (16/19) attachment sites. CONCLUSIONS This series demonstrates the association between Purkinje fibers and FTs during catheter ablation of ILVT and verifies that left ventricular FTs are an important substrate in this type of tachycardia.
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Affiliation(s)
- Wei Ma
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Jiuchun Qiu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fengmin Lu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | | | - Xunzhang Wang
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Le He
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Fan Zhang
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Shaobo Fan
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Enyuan Zhang
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Dongyan Wu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern eater Command, Shenyang, China
| | - Jing Xu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
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Kotake Y, Bennett R, Silva KD, Bhaskaran A, Kanawati J, Turnbull S, Zhou J, Kumar S, Campbell T. Correlation of spatial patterns of endocardial pace mapping to underlying scar topography in patients with scar-related ventricular tachycardia. J Cardiovasc Electrophysiol 2023; 34:638-649. [PMID: 36640432 DOI: 10.1111/jce.15811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Endocardial pace mapping (PM) can identify conducting channels for ventricular tachycardia (VT) circuits in patients with structural heart disease (SHD). Recent findings show the temporal and spatial pattern of PM may aid identification of the surface harboring VT isthmii. The specific correlation of PM patterns to scar topography has not been examined. OBJECTIVE To correlate the pattern of endocardial PMs to underlying scar topography in SHD patients with VT. METHODS Data from patients undergoing VT ablation from August 2018 to February 2022 were reviewed. RESULTS Sixty-three patients with SHD-related VT (mean age 65 ± 14 years) with 83 endocardial PM correlation maps were analysed. Two main correlation patterns were identified, an "abrupt-change correlation pattern (AC-pattern)" and "centrifugal-attenuation correlation pattern (CA-pattern)." AC-pattern had lower scar ratio (unipolar/bipolar % scar area; 1.1 vs. 1.5, p < .001), had longer maximal stimulus-QRS intervals (97.5 vs. 68 ms, p = .002), and higher likelihood of endocardial dominant scar (11/21 [52%] vs. 3/38 [8%], p < .001) than CA-pattern seen on intracardiac echocardiography (ICE). In contrast, CA-pattern was more likely to have epicardial dominant scar or mid-intramural scar on ICE (epicardial dominant scar; CA-pattern: 12/38 [32%] vs. AC-pattern: 1/21 [5%], p = .02, mid-intramural scar; CA-pattern: 15/38 [39%] vs. AC-pattern: 1/21 [5%], p = .005). CONCLUSIONS The spatial pattern of endocardial PM in SHD-related VT directly correlates with scar topography. AC-pattern is associated with endocardial dominant scar on ICE with lower scar ratio and longer stimulus-QRS intervals, whereas CA-pattern is strongly associated with epicardial dominant or mid-intramural scar with higher scar ratio and shorter stimulus-QRS intervals.
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Affiliation(s)
- Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
| | - Richard Bennett
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
| | - Juliana Kanawati
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
| | - Julia Zhou
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Applied Research Center, University of Sydney, New South Wales, Sydney, Australia
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Bayona Molano MDP, Rice S. The Use of Intracardiac Echocardiography in Transjugular Intrahepatic Portosystemic Shunt Procedure. Semin Intervent Radiol 2023; 40:15-18. [PMID: 37152794 PMCID: PMC10159727 DOI: 10.1055/s-0043-1764283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is a complex intervention with a steep learning curve that requires centers of expertise to improve technical success and reduce complications. Portal venous access is the most challenging step of the procedure and requires planning and image guidance strategies to prevent vascular or bile duct injury and further complications. Intracardiac echocardiography (ICE) has been reported to be a safe and accurate tool that provides images of the portal vein anatomy in real time. The use of ICE has become the standard of care in several centers. It is now frequently used to target the portal vein in complex TIPS procedures. This review article describes some technical aspects and indications of ICE-guided TIPS.
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Affiliation(s)
| | - Samuel Rice
- Interventional Radiology Division, UT Southwestern Medical Center, Dallas, Texas
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Nielsen-Kudsk JE, Berti S, Caprioglio F, Ronco F, Arzamendi D, Betts T, Tondo C, Christen T, Allocco DJ. Intracardiac Echocardiography to Guide Watchman FLX Implantation: The ICE LAA Study. JACC Cardiovasc Interv 2023; 16:643-651. [PMID: 36764917 DOI: 10.1016/j.jcin.2022.10.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is increasingly used to guide left atrial appendage closure (LAAC). OBJECTIVES The aim of this study was to investigate the efficacy and safety of ICE-guided LAAC with the Watchman FLX device. METHODS The ICE LAA (I Can See Left Atrial Appendage) study was a prospective, multicenter study with independent adjudication of echocardiographic data by a core laboratory and clinical events by a clinical events committee. Patients with atrial fibrillation with CHA2DS2-VASc scores ≥2 and clinical indications for LAAC were eligible. Preplanning with either cardiac computed tomography or transesophageal echocardiography (TEE) within 7 days prior to LAAC was mandatory. Intraprocedural ICE was carried out from the left atrium. The primary outcome was the rate of significant peri-device leaks (>5 mm) at 45-day TEE. RESULTS A total of 100 patients were enrolled. The mean age was 76 ± 8 years, the mean CHA2DS2-VASc score was 4.0 ± 1.5, and the mean HAS-BLED score was 2.5 ± 0.9. The incidence of the primary outcome of significant peridevice leak (>5 mm) was 0%; all patients evaluated by TEE at 45 days had effective LAAC. All patients received Watchman FLX devices, and technical success was 100%. The number of devices per case was 1.0 ± 0.1. ICE successfully guided the assessment of device release criteria, including device compression (19.2% ± 7.1%; recommended range: 10%-30%). No subject required conversion to TEE. Procedural complications were 4 access-site bleeds. There was no stroke, transient ischemic attack, systemic embolization, pericardial effusion, device embolization, or device-related thrombus during the procedure or 45-day follow-up. CONCLUSIONS ICE can be used to successfully guide LAAC with the Watchman FLX, with excellent procedural success, a high rate of effective LAAC, and minimal periprocedural complications. (I Can See Left Atrial Appendage [ICELAA] Clinical Study; NCT04196335).
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Affiliation(s)
| | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | | | | | | | | | - Claudio Tondo
- Heart Rhythm Center at Monzino Cardiac Center, IRCCS, Department of Biomedical, Surgical and Dentist Sciences, University of Milan, Milan, Italy
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Alkhouli M. The ICE LAA Study: Another Proof of Concept or a PASS to the Future? JACC Cardiovasc Interv 2023; 16:652-654. [PMID: 36764915 DOI: 10.1016/j.jcin.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
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Sakamoto I, Yamamura K, Ishikita A, Ohtani K, Umemoto S, Kaku H, Yamasaki Y, Abe K, Ide T, Tsutsui H. Visibility of Pulmonary Valve and Pulmonary Regurgitation on Intracardiac Echocardiography in Adult Patients with Tetralogy of Fallot. J Cardiovasc Dev Dis 2023; 10:jcdd10010024. [PMID: 36661919 PMCID: PMC9861915 DOI: 10.3390/jcdd10010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Pulmonary regurgitation (PR) is a risk factor for sudden cardiac death in adult patients with repaired tetralogy of Fallot (TOF). However, transthoracic echocardiography (TTE) cannot fully visualize the pulmonary valve (PV) and PR. We investigated whether intracardiac echocardiography (ICE) could visualize the PV and PR better than TTE. Thirty adult patients with TOF (mean age 33 ± 15 years) scheduled for cardiac catheterization underwent ICE. The visualization of PV and the severity of PR were classified into three grades. ICE depicted the PV better than TTE (ICE vs. TTE: not visualized, partially visualized, and fully visualized: n = 1 [3%], n = 13 [43%], and n = 16 [53%] vs. n = 14 [47%], n = 13 [43%], and n = 3 [10%], p < 0.001). Especially in patients after pulmonary valve replacement (PVR), the PV was more fully visualized by ICE. The assessment of PR by TTE underestimated the severity of PR in comparison to cardiac magnetic resonance imaging (MRI) (severe PR: 8 [28%] vs. 22 [76%], p = 0.004), while there was no discrepancy between the results of ICE and MRI (21 [72%] vs. 22 [76%], p = 1.000). In comparison to TTE, ICE can safely provide better visualization of the PV and PR in adults with TOF, especially in patients who have undergone PVR.
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Affiliation(s)
- Ichiro Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Cardiovascular Intensive Care, Fukuoka Children’s Hospital, Fukuoka 813-0017, Japan
- Correspondence:
| | - Ayako Ishikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kisho Ohtani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Cardiovascular Internal Medicine, National Hospital Organization, Kyushu Medical Center, Fukuoka 810-8563, Japan
| | - Shintaro Umemoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hidetaka Kaku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Wong GX, Singh GD. Transcatheter Left Atrial Appendage Closure. Methodist Debakey Cardiovasc J 2023; 19:67-77. [PMID: 37213882 PMCID: PMC10198237 DOI: 10.14797/mdcvj.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 05/23/2023] Open
Abstract
Atrial fibrillation is the most common arrhythmia worldwide, placing a large population at risk for potentially disabling ischemic strokes, yet an estimated 50% of eligible patients cannot tolerate or are contraindicated to receive oral anticoagulation. Within the last 15 years, transcatheter options for left atrial appendage closure (LAAC) have provided a valuable alternative to chronic oral anticoagulation for reducing risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. With newer generation devices such as Watchman FLX and Amulet gaining approval from the US Food and Drug Administration in recent years, several large clinical trials have demonstrated the safety and efficacy of transcatheter LAAC in a population intolerant to systemic anticoagulation. In this contemporary review, we discuss the indications for transcatheter LAAC and the evidence evaluating the use of various device therapies currently available or in development. We also examine current unmet challenges in intraprocedural imaging and controversies in postimplantation antithrombotic regimens. Several ongoing seminal trials are hoping to clarify the role of transcatheter LAAC as a safe, first-line option for all patients with nonvalvular atrial fibrillation.
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Affiliation(s)
- Gordon X. Wong
- University of California, Davis Medical Center, Sacramento, California, US
| | - Gagan D. Singh
- University of California, Davis Medical Center, Sacramento, California, US
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Zhu J, Zhang N, Ma Q, Jin L, Pan X. Intracardiac biopsy of cardiac tumors with echocardiographic guidance: Case report. Front Cardiovasc Med 2023; 10:1103918. [PMID: 37180777 PMCID: PMC10173306 DOI: 10.3389/fcvm.2023.1103918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Background Primary cardiac tumors are very rare, and about 20-30% of them are malignant tumors. Since early signs of cardiac tumors are non-specific, diagnosis can be challenging. There is a lack of the recommended guidelines or standardized strategies for diagnosis and optimal treatment for this disease. As the definite diagnoses of most tumors are made by pathologic confirmation, biopsied tissue is essential in determining the treatment for patients with cardiac tumors. Recently, intracardiac echocardiography (ICE) has been introduced to assist biopsy procedures of cardiac tumors and it provides high-quality imaging. Case Description Due to its low prevalence and variable presentation, cardiac malignant tumors usually are easily missed. Hereby, we report three cases of patients who presented with non-specific signs of cardiac disorder and was initially suspended diagnosis as lung infection or cancer. Under the guidance of ICE, cardiac biopsies were successfully on cardiac masses, giving critical data for diagnosis and treatment planning. No procedural complications were obtained in our cases. These cases are intended to highlight the clinical value and importance of ICE-guided biopsy of intracardiac mass. Conclusions The diagnosis of primary cardiac tumors relies on the histopathological results. In our experience, using ICE for biopsy of an intracardiac mass is an attractive tool to increase diagnostic results and reduce the risk of cardiac complications associated with inadequate targeting of the biopsy catheters.
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Affiliation(s)
- Jinyun Zhu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ning Zhang
- Department of Cardiology, the Affiliated Hangzhou First People’s Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qunchao Ma
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Luhang Jin
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohong Pan
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Correspondence: Xiaohong Pan
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Wang Y, Zhao Y, Zhou K, Zei PC, Wang Y, Cheng H, Chen S, Tao Y, Mao Y, Liu Q, Bangash AB, Sheng X, Sun Y, Zhang P, Yu L, Lin J, Zhang Z, Fu G, Jiang R, Jiang C. Intracardiac echocardiography is a safe and effective alternative to transesophageal echocardiography for left atrial appendage thrombus evaluation at the time of atrial fibrillation ablation: The ICE-TEE study. Pacing Clin Electrophysiol 2023; 46:3-10. [PMID: 36301182 DOI: 10.1111/pace.14601] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) technology has been increasingly accepted as an integral part of atrial fibrillation (AF) ablation procedures. It is still unknown whether ICE can routinely replace transesophageal echocardiography (TEE) for routine thrombus screening in non-selective AF patients. OBJECTIVE To assess whether ICE can routinely replace TEE in screening for left atrial (LA)/left atrial appendage (LAA) thrombus in general patients undergoing catheter ablation for AF. METHODS A total of 2003 consecutive patients undergoing AF ablation were included. 1155 patients (ICE group) received intra-procedural ICE examination for LA/LAA thrombus screening, while 848 patients (TEE group) received pre-procedure TEE examination. The incidence of thrombus, peri-procedure complications, and hospital efficiency were assessed. RESULTS The LA and LAA were adequately visualized in all patients. Five patients in the ICE group and 15 patients in the TEE group were found to have LAA thrombus. The incidence of major periprocedural thrombo-embolic events was comparable between two groups (0.2% vs. 0.1%, p = .76), none were due to undetected LA/LAA thrombus. Other major periprocedural complications occurred at similar rates in both groups, while post-procedure fever was less common in the ICE group (12.7% vs. 17.4%, p < .001). Procedure times and hospital length of stay were both shorter in the ICE group (142 min [87-197 min] vs. 150 min [95-205 min], and 3[2-4] day vs. 4[3-5] day, respectively, both p < .001). CONCLUSIONS ICE can replace TEE for atrial thrombus screening in AF patients undergoing ablation without increased complications. An "ICE replacing TEE" workflow can also reduce the incidence of postoperative fever and improve hospital efficiency.
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Affiliation(s)
- Yuxing Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China
| | - Yi Zhao
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China
| | - Kuangshi Zhou
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China
| | - Paul C Zei
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yunhe Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Cheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shiquan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuhang Tao
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yankai Mao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Abdul Basit Bangash
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianwei Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zuwen Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang Province, China
| | - Ruhong Jiang
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang Province, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang Province, China
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Ma Y, Guo L, Li J, Liu H, Xu J, Du H, Wang Y, Li H, Yi F. Iatrogenic Atrial Septal Defect after Intracardiac Echocardiography-Guided Left Atrial Appendage Closure: Incidence, Size, and Clinical Outcomes. J Clin Med 2022; 12:jcm12010160. [PMID: 36614961 PMCID: PMC9821275 DOI: 10.3390/jcm12010160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The data on iatrogenic atrial septal defect (iASD) after left atrial appendage closure (LAAC), especially intracardiac echocardiography (ICE)-guided LAAC, are limited. Compared with transesophageal echocardiography (TEE)- or digital subtraction angiography (DSA)-guided LAAC, the transseptal puncture (TP) ICE-guided LAAC is more complicated. Whether or not ICE-guided TP increases the chances of iASD is controversial. We investigate the incidence, size, and clinical outcomes of iASD after ICE-guided LAAC. METHODS A total of 177 patients who underwent LAAC were enrolled in this study and were assigned to the ICE-guided group (group 1) and the TEE- or DSA-guided group (group 2). Echocardiography results and clinical performances at months 2 and 12 post-procedure were collected from the electronic outpatient records. RESULTS A total of 112 and 65 patients were assigned to group 1 and group 2, respectively. The incidence of iASD at follow-up (FU) month 2 was comparable between the groups (21.4% in group 1 vs. 15.4% in group 2, p = 0.429). At month 12 of FU, the closure rate of iASD was comparable to that of group 2 (70.6% vs. 71.4%, p = 1.000). No right-to-left (RL) shunt was observed among the iASD patients during the FU. Numerically larger iASD were observed in group 1 patients at month 2 of FU (2.8 ± 0.9 mm vs. 2.2 ± 0.8 mm, p = 0.065). No new-onset of pulmonary hypertension and iASD-related adverse events were observed. Univariable and multivariable logistic regression analysis showed that ICE-guided LAAC was not associated with the development of iASD (adjusted OR = 1.681; 95%CI, 0.634-4.455; p = 0.296). CONCLUSIONS The ICE-guided LAAC procedure does not increase the risk of iASD. Despite the numerically large size of the iASD, it did not increase the risk of developing adverse complications.
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Deshpande S, Sawatari H, Ahmed R, Nair RG, Khan H, Khanji MY, Somers VK, Chahal CAA, Padmanabhan D. Impact of intracardiac echocardiography on readmission morbidity and mortality following atrial fibrillation ablation. J Cardiovasc Electrophysiol 2022; 33:2496-2503. [PMID: 36128625 DOI: 10.1111/jce.15683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The use of intracardiac echocardiography (ICE) is beneficial during the ablation of atrial fibrillation (AF). Evidence is conflicting regarding the clinical impact of using ICE on arrhythmia recurrence and mortality. METHODS Patients undergoing catheter ablation of AF during 2010-2017 were identified using the International Classification of Diseases-9th and 10th Revision-Clinical Modification (ICD-9-CM and ICD-10-CM) from the Nationwide Readmissions Database. Propensity matching was used to generate a control group. Patient demographics, Charlson comorbidity indexes, time from discharge to readmission, and the reason of readmission were extracted. RESULTS From 2010 to 2017, 51 129 patients were included in the analysis out of which ICE was used in 8005 (15.7%) patients. The in-hospital mortality at readmission was significantly higher in the patients without ICE use (2.9% vs. 1.7%, p = .02). The length of stay (LOS) at readmission was significantly higher in non-ICE arm (median [interquartile range, IQR]: 3 [2-6] vs. 2 [3-5] days, p < .0001) with similar healthcare-associated cost (HAC) in both the groups (median [IQR]: US$7507.3 [4057.8-15 474.2] vs. 7339.4 [4024.8-15 191.6], p = .43). Freedom from readmission was 12% higher (hazard ratio [HR] [95% confidence interval, CI]: 0.88 [0.83-0.94], p < .0001) with the use of ICE at 90-day follow-up, which was driven by 24% reduction in heart failure (HF) at follow-up (HR [95% CI]: 0.76 [0.60-0.96], p = .02). CONCLUSIONS ICE use during AF ablation procedure reduces readmissions at 90 days by 12%, driven by a 24% decrease in HF-related admissions. The non-ICE arm showed a significantly higher LOS which offsets marginally higher HAC in the ICE arm.
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Affiliation(s)
- Saurabh Deshpande
- Department of Cardiac Electrophysiology, Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Hiroyuki Sawatari
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Raheel Ahmed
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle, UK
| | - Rakesh Gopinathan Nair
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Hassan Khan
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - C Anwar A Chahal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiac Electrophysiology Section, Division of Cardiovascular Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deepak Padmanabhan
- Department of Cardiac Electrophysiology, Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Akerström F, Drca N, Jensen‐Urstad M, Braunschweig F. Feasibility of a novel algorithm for automated reconstruction of the left atrial anatomy based on intracardiac echocardiography. Pacing Clin Electrophysiol 2022; 45:1288-1294. [PMID: 36193687 PMCID: PMC9828825 DOI: 10.1111/pace.14599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/31/2022] [Accepted: 09/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is frequently used to guide electrophysiology procedures. The novel automated algorithm Cartosoundfam is a model-based algorithm which reconstructs a 3D anatomy of the left atrium (LA) based on a set of 2D intracardiac echocardiography (ICE) frames, without the need to manually annotate ultrasound (US) contours. OBJECTIVE The aim of this study was to determine the feasibility of the Cartosoundfam module in routine clinical setting. METHODS We included 16 patients undergoing LA mapping/catheter ablation. Two-dimensional US frames were acquired from the right atrium (RA) and the right ventricular outflow tract. The Cartosoundfam map was validated in two steps: (1) identification of anatomical structures (pulmonary veins [PV] and LA body and appendage) by alignment of the ablation catheter to the automated map; and (2) analysis of the automated lesion tags (Visitag) location in relation to the PV antrum of the Cartosoundfam map in nine patients with paroxysmal atrial fibrillation (AF) undergoing first time pulmonary vein isolation (PVI). RESULTS Mean 2D US frames per patient were 29 ± 6 and acquisition time was 16 ± 4 min. All anatomical structures were correctly identified in all patients (step 1). In the step 2 validation, the median distance to the map was 2.0 (IQR: 2.4) mm and the majority of the Visitags were classified as satisfactory (69%) but all PV segments had some Visitags classified as unsatisfactory. CONCLUSION The automated ICE-based algorithm correctly identified the LA anatomical structures in all patients with a 69% anatomical accuracy of the Visitags alignments to the PV antrum segments.
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Affiliation(s)
- Finn Akerström
- Department of CardiologyKarolinska University HospitalStockholmSweden,Department of Medicine HuddingeKarolinska InstitutetStockholmSweden
| | - Nikola Drca
- Department of CardiologyKarolinska University HospitalStockholmSweden,Department of Medicine HuddingeKarolinska InstitutetStockholmSweden
| | - Mats Jensen‐Urstad
- Department of CardiologyKarolinska University HospitalStockholmSweden,Department of Medicine HuddingeKarolinska InstitutetStockholmSweden
| | - Frieder Braunschweig
- Department of CardiologyKarolinska University HospitalStockholmSweden,Department of Medicine SolnaKarolinska InstitutetStockholmSweden
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Vanhaverbeke M, Nuyens P, Bieliauskas G, Sondergaard L, Vejlstrup N, De Backer O. Facilitation techniques to cross the interatrial septum with intracardiac echocardiography during left atrial appendage closure. Catheter Cardiovasc Interv 2022; 100:795-800. [PMID: 35880854 PMCID: PMC9796577 DOI: 10.1002/ccd.30348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/12/2022] [Accepted: 07/16/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study aimed to assess the rate of difficult interatrial septum (IAS) crossing with the intracardiac echocardiography (ICE) probe during percutaneous left atrial appendage (LAA) closure and to identify techniques that facilitate IAS crossing with the ICE probe. BACKGROUND Percutaneous LAA closure is increasingly performed by ICE guidance. Although such an approach omits the need for general anesthesia, crossing of the IAS with the ICE probe may sometimes be challenging. METHODS All consecutive patients that underwent ICE-guided percutaneous LAA closure with an Amplatzer Amulet (Abbott) or WatchmanFLX (Boston Scientific) at our center in the period 2018-2021 were included. Cases in which IAS crossing with ICE was difficult were identified and techniques used to facilitate IAS crossing were identified and listed. RESULTS In 17 (5%) out of 354 cases, IAS crossing with the ICE probe was difficult and required use of additional techniques. Ultimately, IAS crossing was also successful in these 17 cases by using one of three possible facilitation techniques: the probing technique (12 cases), the double-wire technique (3 cases), and the snaring technique (2 cases). In one case, the double-wire technique was converted to the snaring technique, as crossing of the ICE probe remained challenging despite the use of two stiff guidewires. CONCLUSION Crossing of the IAS with the ICE probe can be challenging in 5% of ICE-guided percutaneous LAA closure procedures. Operators should be aware of possible facilitation techniques in challenging cases, as these show to be safe and effective.
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Ma C, Chen T, Chen Y, Ge J, Han W, Wang Q, Zhong J. Understanding the scope of intracardiac echocardiography in catheter ablation of ventricular arrhythmia. Front Cardiovasc Med 2022; 9:1037176. [PMID: 36386380 PMCID: PMC9650380 DOI: 10.3389/fcvm.2022.1037176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/14/2022] [Indexed: 01/03/2024] Open
Abstract
Over the last few decades, catheter ablation has emerged as the first-line treatment for ventricular arrhythmias. However, detailed knowledge of cardiac anatomy during the surgery remains the prerequisite for successful ablation. Intracardiac echocardiography (ICE) is a unique imaging technique, which provides real-time visualization of cardiac structures, and is superior to other imaging modalities in terms of precise display of cardiac tissue characteristics as well as the orientation of anatomical landmarks. This article aimed to introduce the various advantages and limitations of ICE in the ablation of ventricular arrhythmias.
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Affiliation(s)
- Chuanzhen Ma
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanbo Chen
- Department of Cardiology, Weifang People’s Hospital, Weifang, China
| | - Junye Ge
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qinhong Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Jingquan Z, Deyong L, Huimin C, Hua F, Xuebin H, Chenyang J, Yan L, Xuebin L, Min T, Zulu W, Yumei X, Jinlin Z, Wei Z, Xiaochun Z, Daxin Z, Yun Z, Changsheng M, Zei PC, Di Biase L. Intracardiac echocardiography Chinese expert consensus. Front Cardiovasc Med 2022; 9:1012731. [PMID: 36277762 PMCID: PMC9584059 DOI: 10.3389/fcvm.2022.1012731] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, percutaneous catheter interventions have continuously evolved, becoming an essential strategy for interventional diagnosis and treatment of many structural heart diseases and arrhythmias. Along with the increasing complexity of cardiac interventions comes ever more complex demands for intraoperative imaging. Intracardiac echocardiography (ICE) is well-suited for these requirements with real-time imaging, real-time monitoring for intraoperative complications, and a well-tolerated procedure. As a result, ICE is increasingly used many types of cardiac interventions. Given the lack of relevant guidelines at home and abroad and to promote and standardize the clinical applications of ICE, the members of this panel extensively evaluated relevant research findings, and they developed this consensus document after discussions and correlation with front-line clinical work experience, aiming to provide guidance for clinicians and to further improve interventional cardiovascular diagnosis and treatment procedures.
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Affiliation(s)
- Zhong Jingquan
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China,*Correspondence: Zhong Jingquan,
| | - Long Deyong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China,Long Deyong,
| | - Chu Huimin
- Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Fu Hua
- West China Hospital, Sichuan University, Chengdu, China
| | - Han Xuebin
- The Affiliated Cardiovascular Hospital, Shanxi Medical University, Taiyuan, China
| | - Jiang Chenyang
- Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Li Yan
- Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Li Xuebin
- Peking University People’s Hospital, Beijing, China
| | - Tang Min
- Fuwai Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang Zulu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Xue Yumei
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | | | - Zhang Wei
- Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | | | - Zhou Daxin
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhang Yun
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ma Changsheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Paul C. Zei
- Brigham and Women’s Hospital, Boston, MA, United States
| | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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Albertini L, HA AC, Nair K. Ebstein's Anomaly: How to Identify Intracardiac Structures When Electrical Signals Do Not Match the Anatomy. J Innov Card Rhythm Manag 2022; 13:5181-5182. [PMID: 36196236 PMCID: PMC9521723 DOI: 10.19102/icrm.2022.130906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
In patients with Ebstein's anomaly, the distorted anatomy with discordance between the true atrioventricular (AV) groove and the tricuspid valve poses many challenges to the electrophysiologist. Intracardiac echocardiography is a recent tool that allows visualization of the displaced tricuspid valve, the true AV groove, and the atrialized right ventricle. We present a 3-dimensional electroanatomic map built using intracardiac echocardiography and the CARTOSOUND® module (Biosense Webster, Diamond Bar, CA, USA) in one such patient who underwent ablation of a right-sided mid-septal accessory pathway.
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Affiliation(s)
- Lisa Albertini
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew C.T. HA
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Krishnakumar Nair
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada,Address correspondence to: Krishnakumar Nair, MD, 3 Floor, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, M5G 2C4, Canada.
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