Does the use of intracardiac echocardiography during atrial fibrillation catheter ablation improve outcomes and cost? A nationwide 14-year analysis from 2001 to 2014

Isath, Ameesh; Padmanabhan, Deepak; Haider, Sajjad; Siroky, Gregory P.; Perimbeti, Stuthi; Correa, Ashish; Chahal, C. Anwar A.; Shenthar, Jayaprakash; Asirvatham, Samuel; Mehta, Davendra

doi:10.1007/s10840-020-00844-5

Cited by 34 publications

(45 citation statements)

References 17 publications

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“…The application of ICE during AF ablation has increased over the years and is associated with lower procedural complications and in‐hospital mortality 14 . Several studies to date have evaluated the feasibility and outcome of zero‐fluoroscopy catheter ablation of AF with combined use of a three‐dimensional electro‐anatomic mapping system and ICE 15,16 .…”

Section: Discussionmentioning

confidence: 99%

“…The application of ICE during AF ablation has increased over the years and is associated with lower procedural complications and inhospital mortality. 14 Several studies to date have evaluated the feasibility and outcome of zero-fluoroscopy catheter ablation of AF with combined use of a three-dimensional electro-anatomic mapping system and ICE. 15,16 Our study applied the currently available technologies: ICE, CartoSound electroanatomical mapping system, and contact force sensing catheter, along with high power ablation strategy 17 and AI guidance.…”

Section: Efficacy and Safety Of Ai-guided High-power Fluoroless Af Ab...mentioning

confidence: 99%

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Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Chen

Wang

Zhou

et al. 2022

Cardiovasc electrophysiol

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Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) are sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. We aim to evaluate the clinical outcomes and safety of ICE-guided LAAC within a zerofluoroscopy catheter ablation procedure.Methods and Results: From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC were achieved in all patients.Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 75.0% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA 2 DS 2 -VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Efficacy and Safety Of Ai-guided High-power Fluoroless Af Ab...mentioning

confidence: 99%

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Chen

Wang

Zhou

et al. 2022

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…The application of ICE during AF ablation has increased over the years and is associated with lower procedural complications and in-hospital mortality. 14 Very few studies to date have evaluated the feasibility and outcome of zero-fluoroscopy catheter ablation of AF with combined use of a three-dimensional electroanatomic mapping system and ICE. 15,16 Our study applied the currently available technologies: ICE, CAR-TOSOUND electroanatomical mapping system and contact force sensing catheter, along with high power ablation strategy 17 and AI guidance 18 .…”

Section: Discussionmentioning

confidence: 99%

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero-fluoroscopy atrial fibrillation ablation procedures

Chen

Wang

Zhou

et al. 2021

Preprint

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Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) is sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. To evaluate the clinical outcomes and safety of ICE guided LAAC within a zero-fluoroscopy catheter ablation procedure. Methods and Results:From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC was achieved in all patients. Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 77.8% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA2DS2-VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to a single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

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“…The characteristics of studies included in the meta-analysis were summarized in Table 1. As is shown in Table 1, five studies were randomized controlled trials (RCTs), 12,13,17,20,23 six were retrospective studies 14,16,18,19,21,22 and one was prospective study. 15 The mean age of the population ranged from 51.6 ± 11.9 to 65.8 ± 9.8 years.…”

Section: Study Characteristics and Risk Of Bias Assessmentmentioning

confidence: 99%

Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta‐analysis of observational and randomized studies

Gao

Liu

et al. 2022

Cardiovasc electrophysiol

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Introduction: Intracardiac echocardiography (ICE) provides superior quality images and can monitor catheter location within the heart continuously. Given the limited evidence, we conducted the meta-analysis to evaluate outcomes with ICE in radiofrequency (RF) ablation of atrial fibrillation (AF). Methods and Results: PubMed/MEDLINE, Embase, and Cochrane were searched for studies reporting RF ablation for treatment of AF with the use of ICE versus without ICE and 12 studies were included. Sensitivity analyses limiting studies to ablation with the use of contact force (CF) catheters were conducted and subgroup analyses were performed according to the published year. In main analyses, RF ablation with ICE for treatment of AF was associated with significant reduction in total X-ray time (mean difference [MD], −9.80; 95% confidence interval [CI], −15.57 to −4.04;I 2 = 99%; p < .01), total procedure time (MD, −17.65; 95% CI, −30.22 to −5.09; I 2 = 89%; p < .01), and complications (relative risk [RR], 0.90; 95% CI, 0.87-0.92; I 2 = 20%; p < .01) versus without ICE. The ICE-guided group tended to decrease total absorbed X-ray dose (standardized mean difference, −0.91; 95% CI, −1.86 to 0.04; I 2 = 96%; p = .06). Freedom from arrhythmia (RR, 1.06; 95% CI, 0.98-1.14; I 2 = 0%; p = .13) was comparable between the two groups. Conclusion:In patients with AF, ICE-guided RF ablation is correlated with significant reductions in total X-ray time, total procedure time, and complications versus ablation without ICE. Total absorbed X-ray dose tends to reduce in the ICE group and freedom from arrhythmia is comparable between the two groups.

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Does the use of intracardiac echocardiography during atrial fibrillation catheter ablation improve outcomes and cost? A nationwide 14-year analysis from 2001 to 2014

Cited by 34 publications

References 17 publications

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero‐fluoroscopy atrial fibrillation ablation procedures

Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero-fluoroscopy atrial fibrillation ablation procedures

Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta‐analysis of observational and randomized studies

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