Intracardiac Echocardiography to Guide Non-fluoroscopic Electrophysiology Procedures

Kautzner, Josef; Haskova, Jana; Lehar, František

doi:10.1016/j.ccep.2021.03.004

Cited by 8 publications

(6 citation statements)

References 34 publications

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“…Intracardiac echocardiography has gained ground as an imaging technique for performing structural procedures, including atrial septal defect closures and transcatheter aortic valve replacements 26,27 . Today, it is mostly used in electrophysiology labs, where it has become an essential tool for guiding ablation of various types of arrhythmias, even allowing procedures to be performed without the need for fluoroscopy 28 . In AF ablation, a procedure which requires transeptal puncture, the use of ICE reduces (or even eliminates) the need for fluoroscopy and the rate of complications 29 .…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage occlusion guided by intracardiac echocardiography vs. transesophageal echocardiography: a systematic review

Díaz,

Bastidas,

Aristizábal

et al. 2024

RCCARE

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Left atrial appendage occlusion has proven to be an effective strategy in reducing the risk of stroke and systemic embolism in patients with atrial fibrillation. Worldwide, most left atrial appendage occlusions are performed using transesophageal echocardiography, which requires the use of monitored anesthesia care or general anesthesia, resulting in prolonged in-room and procedural times, delays in procedural scheduling (due to a low availability of anesthetic and echocardiography services) and the risks associated with anesthesia per se. Moreover, the additional personnel required to perform left atrial appendage occlusion guided by transesophageal echocardiography increases the number of people exposed to ionizing radiation, which is particularly high for the transesophageal echocardiography operator, who stands beside the fluoroscopy tube and frequently introduces his/her hands into the fluoroscopy field. Intracardiac echocardiography has gained acceptance to guide left atrial appendage occlusion in recent years, given its high availability in electrophysiology labs, as well as its potential to reduce in-room and procedural times, reduce the need for extensive recovery times, avoid the use of general anesthesia and facilitate same-day discharge, all of which could result in a reduction of total procedure-related costs. In this article, we discuss the evidence supporting the use of intracardiac echocardiography guidance during left atrial appendage occlusion.

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Section: Discussionmentioning

confidence: 99%

Left atrial appendage occlusion guided by intracardiac echocardiography vs. transesophageal echocardiography: a systematic review

Díaz,

Bastidas,

Aristizábal

et al. 2024

RCCARE

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“…Previous studies have combined CT-scan reconstructed cardiac anatomy with fluoroscopic acquisition with Carto Univu, which allows for the overlay of catheter-acquired cardiac maps into fluoroscopy, which can then be used as a reference for cardiac anatomy during atrial fibrillation ablation [ 7 ]. Given the increasing awareness of radiation exposure in interventional electrophysiology, several approaches for fluoroscopy-free procedures have been proposed [ 8 , 9 , 10 ]. Recently, fluoroless TSP has been attempted in some centers and demonstrated as a feasible approach [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

Transseptal Puncture Guided by Three-Dimensional Electroanatomical Mapping: Early Experience Using a Simplified Approach in Adults with Congenital Heart Disease

Guan¹,

Gass

Berger

et al. 2023

JCM

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Aims: The widespread use of three-dimensional (3D) mapping systems and echocardiography in the field of cardiac electrophysiology has made it possible to perform transseptal punctures (TSP) with low or no fluoroscopy. However, such attempts in adults with congenital heart disease (ACHD) who have previously undergone surgical or interventional treatment are limited. Therefore, we sought to explore the feasibility and safety of an approach to perform zero- or low-fluoroscopy TSP in ACHD patients undergoing left atrial cardiac ablation procedures. Methods and results: This study included 45 ACHD patients who underwent TSP for ablation of left-sided tachycardias (left atrium or pulmonary venous atrium). Computed tomography (CT) of the heart was performed in all patients prior to ablation. 3D mapping of the right-sided heart chambers before TSP was used to superimpose the registered anatomy, which was subsequently used for the mapping-guided TSP technique. TSP was performed with zero-fluoroscopy in 27 patients, and the remaining 18 patients had a mean fluoroscopy exposure of 315.88 ± 598.43 μGy.m2 and a mean fluoroscopy duration of 1.9 ± 5.4 min. No patient in this cohort experienced TSP-related complications. Conclusion: Our study describes a fluoroscopy-free or low-dose fluoroscopy approach for TSP in ACHD patients undergoing catheter ablation of left-sided tachyarrhythmias who had been previously treated surgically or interventionally due to congenital heart defects. By superimposing 3D electroanatomic mapping with cardiac CT anatomy, this protocol proved to be highly effective, feasible and safe.

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“…The types of ICE systems available so far are Radial ICE (Ultra ICE™, Boston Scientific, Marlborough, MA, USA), ViewFlex™ Xtra ICE catheter (Abbott, Chicago, IL, USA), and ACUSON Acunav (J&J, New Brunswick, NJ, USA) [10]. ICE has been demonstrated to be a safe and feasible modality to provide localization of diagnostic and ablation catheters and real-time high-resolution images of cardiac structures with a significant reduction in fluoroscopy time exposure [48][49][50]. Unlike transesophageal echocardiography (TOE), ICE does not require sedation and can be performed by the same operator that performs the EP procedure [10].…”

Section: Intracardiac Echocardiographymentioning

confidence: 99%

The Fluoroless Future in Electrophysiology: A State-of-the-Art Review

Preda,

Bonvicini,

Coradello

et al. 2024

Diagnostics

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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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Intracardiac Echocardiography to Guide Non-fluoroscopic Electrophysiology Procedures

Cited by 8 publications

References 34 publications

Left atrial appendage occlusion guided by intracardiac echocardiography vs. transesophageal echocardiography: a systematic review

Left atrial appendage occlusion guided by intracardiac echocardiography vs. transesophageal echocardiography: a systematic review

Transseptal Puncture Guided by Three-Dimensional Electroanatomical Mapping: Early Experience Using a Simplified Approach in Adults with Congenital Heart Disease

The Fluoroless Future in Electrophysiology: A State-of-the-Art Review

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