Intracardiac echocardiography-guided transseptal puncture for fluoroless catheter ablation of left-sided tachycardias

Žižek, David; Antolič, Bor; Kalinšek, Tine Prolič; Štublar, Jernej; Kajdič, Nina; Jelenc, Marjetka; Jan, Matevž

doi:10.1007/s10840-020-00858-z

Cited by 40 publications

(41 citation statements)

References 18 publications

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“…ICE was used in conjunction with the 3D EAM system in all procedures. ICE had four basic roles: Providing guidance of guide-wire, long sheath, and trans-septal needle during trans-septal puncture (TSP) as previously described [ 25 ]. Providing additional imaging information about heart anatomy relevant for accurate and effective endocardial mapping and ablation.…”

Section: Methodsmentioning

confidence: 99%

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Minimising radiation exposure in catheter ablation of ventricular arrhythmias

Jan

Žižek

Kalinšek

et al. 2021

BMC Cardiovasc Disord

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Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

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Section: Methodsmentioning

confidence: 99%

“…Providing guidance of guide-wire, long sheath, and trans-septal needle during trans-septal puncture (TSP) as previously described [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

Minimising radiation exposure in catheter ablation of ventricular arrhythmias

Jan

Žižek

Kalinšek

et al. 2021

BMC Cardiovasc Disord

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“…Fluoroless ICE‐guided workflow for achieving transseptal access was described before 13 [also see Supplemental video]. Briefly, the long guidewire was inserted into superior vena cava (SVC) under ICE guidance.…”

Section: Methodsmentioning

confidence: 99%

Integrated 3D intracardiac ultrasound imaging with detailed pulmonary vein delineation guided fluoroless ablation of atrial fibrillation

Antolič

Kajdič

Vrbajnscak

et al. 2021

Pacing Clinical Electrophis

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Background Intracardiac echocardiography (ICE) has become an all‐round tool for ablation of atrial fibrillation (AF) since it plays an important role in all procedural steps. The key upgrade to the usefulness of ICE is its integration into three‐dimensional (3D) electroanatomic mapping (EAM) system (ICE/EAM automatic integration system). The aim of this single‐center retrospective study was to evaluate feasibility, safety and acute efficacy of ICE/EAM automatic integration system guided fluoroless ablation of AF. Methods The study included patients with symptomatic paroxysmal or persistent AF undergoing first pulmonary vein isolation (PVI) radiofrequency (RF) catheter ablation (RFCA) from September 2017 to August 2020. All procedures were performed without the use of fluoroscopy. A detailed 3D virtual anatomy of the left atrium (LA) and structures relevant to AF ablation was constructed from ultrasound contours obtained with ICE probe inside the LA. Pulmonary veins (PVs) and antral regions were additionally mapped with fast anatomical mapping (FAM). PVI was performed with contact force (CF) sensing catheter. Procedural endpoint was successful PVI. Results A total of 98 consecutive patients underwent RFCA (34.7% females, median age 64.4 years, 64.3% paroxysmal AF). Acute PVI was achieved in all patients (100%). Forty‐three patients (43.9%) underwent additional ablations for concomitant arrhythmias. Adverse events were detected in four patients (4.1%). The median procedure duration was 130 min (IQR 103.8‐151.3). If only PVI was done the median procedure duration was 110.5 (IQR 100.0‐133.8) Conclusions ICE/EAM automatic integration system guided fluoroless ablation of AF is feasible, safe and acutely effective method for treatment of symptomatic AF.

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“…1. Providing guidance of guide-wire, long sheath, and trans-septal needle during trans-septal puncture (TSP) as previously described 25 .…”

Section: Fluoroscopy Minimising Approachmentioning

confidence: 99%

Minimising Radiation Exposure in Catheter Ablation of Ventricu-lar Arrhythmias

Jan

Žižek

Kalinšek

et al. 2021

Preprint

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BackgroundConventional fluoroscopy (CF) guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD).MethodsFifty-two (age 53.4±17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional (3D) electro-anatomical mapping (EAM) system and intra-cardiac echocardiography (ICE). Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed.ResultsSixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9±71.7 vs 123.6±42.2 minutes; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p= 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p= 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complications were low (3/60, 5%).ConclusionsFluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

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Intracardiac echocardiography-guided transseptal puncture for fluoroless catheter ablation of left-sided tachycardias

Cited by 40 publications

References 18 publications

Minimising radiation exposure in catheter ablation of ventricular arrhythmias

Minimising radiation exposure in catheter ablation of ventricular arrhythmias

Integrated 3D intracardiac ultrasound imaging with detailed pulmonary vein delineation guided fluoroless ablation of atrial fibrillation

Minimising Radiation Exposure in Catheter Ablation of Ventricu-lar Arrhythmias

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