Impact of Systematic Use of Intracardiac Ultrasound during Transseptal Catheterization in the Electrophysiology Laboratory

Abstract

Aims: To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. Methods: A retrospective multicenter study collecting data from consecutive atrial fibrillation (AF) and supraventricular ablation procedures that required TSC was performed in five Italian centers. Based on physician discretion, TSC was performed with or without ICE. Periprocedural complications, separating all complications from complications directly related to TSC, were collected. Independent predictors of periprocedural complications and TSC-related complications were investigated. Results: A total of 2181 TSCs were performed on 1862 patients at five Italian centers from 2006 to 2021, in 76% of cases by AF ablation and in 24% by ablation of other arrhythmias with a circuit in the left atrium. Overall, 1134 (52%) procedures were performed with ICE support and 1047 (48%) without ICE. A total of 67 (3.1%) complications were detected, 19 (1.7%) in the ICE group and 48 (4.6%) in the no ICE group, p < 0.001. A total of 42 (1.5%) complications directly related to TSC: 0.9% in the ICE group and 3.1% in the no ICE group (p < 0.001). The independent predictors of all complications were age (OR 1,02 95% C.I 1.00–1.05; p = 0.036), TSC with the use of ICE (OR 0.27 95% C.I 0.15–0.46; p < 0.001) and AF ablation (OR 2,25 95%C.I 1.05–4.83; p = 0.037). The independent predictors for TSC complications were age (OR 1.03 95% C.I 1.01–1.06; p = 0.013) and TSC with the use of ICE (OR 0.24 95% C.I 0.11–0.49; p < 0.001). Conclusions: ICE reduced periprocedural and TSC-related complications during electrophysiological procedures for ablation of left atrial arrhythmias.

Bipolar catheter ablation with dedicated radiofrequency system for highly refractory ventricular arrhythmia—Does the rate of success depend on arrhythmia origin?

“…The best example of a technique which significantly improved ablation procedures during everyday EP practice is ICE. It has been shown that ICE imaging improves EP lab workflow in terms of safety and efficacy and decreases periprocedural complications and duration of complex procedures 22–25 . In cases of idiopathic VA ablation, it was also valuable to be able to discern pouches in the interventricular septum.…”

“…It has been shown that ICE imaging improves EP lab workflow in terms of safety and efficacy and decreases periprocedural complications and duration of complex procedures. [22][23][24][25] In cases of idiopathic VA ablation, it was also valuable to be able to discern pouches in the interventricular septum. Thanks to ICE imaging, steerable sheath retrograde access via femoral artery could be limited only to detailed mapping of LVOT/aortic cusps.…”

Intracardiac Echocardiography: An Invaluable Tool in Electrophysiological Interventions for Atrial Fibrillation and Supraventricular Tachycardia

“…Bottoni et al . [ 11 ] conducted a large comparative study and analyzed 2181 TSPs performed on 1862 patients. A significant difference was found between the complication rates related to TSP of groups undergoing TSP with and without ICE (0.9% vs. 3.1%, p 0.001).…”