The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation

Abstract

Aims: Intracardiac echocardiography (ICE) is a relatively young technique used during complex electrophysiology proce-dures, such as atrial fibrillation (AF) ablation. The aim of this study was to assess whether the use of ICE modifies the radia-tion exposure at the beginning of the learning curve in AF ablation. Materials and methods: In this retrospective study, 52 patients, in which catheter ablation for paroxysmal or persistent AF was performed, were included. For 26 patients we used ICE guidance together with fluoroscopy, whereas for the remaining 26 patients we used fluoroscopy alone, all supported by electroanatomical mapping. We compared total procedure time and radiation exposure, including fluoroscopy dose and time between the two groups and along the learning curve. Results: Most of the patients included were suffering from paroxysmal AF (40, 76%), pulmonary vein isolation being performed in all patients, without secondary ablation sites. The use of ICE was associated with a lower fluoroscopy dose (11839.60±6100.6 vs. 16260.43±8264.5 mGy, p=0.041) and time (28.00±12.5 vs. 42.93±12.7 minutes, p=0.001), whereas the mean procedure time was similar between the two groups (181.54±50.3 vs 197.31±49.8 minutes, p=0.348). Radiation exposure was lower in the last 9 months compared to the first 9 months of the study (p<0.01), decreasing gradually along the learning curve. Conclusions: The use of ICE lowers radiation exposure in AF catheter ablation from the beginning of the learning curve, without any difference in terms of acute safety or efficacy. Aware-ness towards closest to zero radiation exposure during electrophysiology procedures should increase in order to achieve better protection for both patient and medical staff.

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

“…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.…”

“…The data on total absorbed X-ray dose was reported in six studies 12,13,15,19,20,22 Figure S3). Based on the year of publication, we performed a subgroup analysis and observed that the result of total absorbed X-ray dose was comparable between the two groups in the subgroup of studies published over 5 years (SMD, −0.78; 95% CI, −2.39 to 0.83; I 2 = 96%; p = .34; Figure 6).…”

“…The data on complications was available in 11 [12][13][14][15][16][17][18][19][21][22][23] studies, with no evidence for significant heterogeneity (I 2 = 20%). Compared to ablation without ICE, ICE guidance in RF ablation was related to a F I G U R E 4 Forest plot and subgroup analysis of total X-ray time in RF ablation of AF with the use of ICE (experimental) versus without ICE (control).…”

“…Nine studies 12,14,15,17,18,[20][21][22][23] enrolled patients with all type of AF. The mean follow-up ranged from 9.2 ± 2.2 months to 2 ± 1 years, excluding four studies 14,16,18,22 In light of the Cochrane risk bias assessment tool, each study included in the meta-analysis was classified as low risk, high risk, and unclear risk. Figure 2A presents the summary of the risk of bias for each study individually and Figure 2B presents the overall risk of bias.…”

Acute Lesion Imaging in Predicting Chronic Tissue Injury in the Ventricles

“…Real time MRI can be used to target fibrotic lesions (arrhythmogenic substrates) or visualize scar formation (23). Other imaging modalities, such as intracardiac echography (ICE) are more integrated in clinical practice (24).…”