Intracardiac echocardiography versus fluoroscopy for endovascular and endocardial catheter navigation during cryo-ablation of the slow pathway in AVNRT patients

Abstract

Background A new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients. Methods Clinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution. Results Slow pathway ablation or modulation was successful in all patients. Fluoroscopy time and radiation dose in the fluoroscopy group were 11.2 ± 9.0 min and 20.3 ± 16.2Gycm 2 , whereas no fluoroscopy was used in the opposite group ( p < 0.001, respectively). EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.). Conclusions Zero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques. Trial registration (German Clinical Trials Register ID: DRKS00011360 ; Registration Date 14.12.2016) Electronic supplementary material The online version of this article (10.1186/s12947-019-0162-2) contains supplementary material, which is available to authorized users.

Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population

“…Examples include: recognition of important anatomical variations, control of catheter tip orientation, control of catheter-tissue contact, and early recognition of complications such as pericardial effusion and procedure-related thrombi [ 23 , 31 ]. There are scarce data on improved results of ablation in ICE-guided AVNRT procedures [ 34 , 35 ]. However, we find ICE to be a valuable tool in small children with a smallish Koch triangle, when precise positioning of the catheter on the ablation spot is of great value for successful ablation and complication avoidance.…”

Randomized trial of intracardiac echocardiography-guided slow pathway ablation

“…Previously studies reported on the advantage of mechanical radial ICEimaging for SP ablation [18,19]. Most recently, data from a retrospective analysis of 47 patients who underwent ICE vs. fluoroscopy-guided SP cryoablation showed that the use of ICE shortens the cryo-application duration; however, time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance [20].…”

Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology

“…Recently, the “Ice and ICE” study looked at the safety and efficacy of conventional fluoroscopy-guided cryoablation with ICE-guided cryoablation of AV-nodal re-entrant tachycardia (AVNRT) [ 33 •]. In this small retrospective comparative study, all patients (22 in ICE arm and 25 in fluoroscopy arm) had successful modification of the slow pathway with similar overall procedure times without major complication events reported.…”