Zero‐fluoroscopy cryothermal ablation of atrioventricular nodal re‐entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&amp;ICE Trial)

Luani, Blerim; Zrenner, Bernhard; Basho, Maksim; Genz, Conrad; Rauwolf, Thomas; Tanev, Ivan; Schmeißer, Alexander; Braun-Dullaeus, Rüdiger C.

doi:10.1111/jce.13354

Cited by 16 publications

(12 citation statements)

References 26 publications

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“…However, these techniques, including 3D-EAM, require a change in work flow, certain experiences in CA, and a learning curve to reduce the ionising radiation exposure. There have been reports of CA with zero fluoroscopy using intracardiac echocardiography 11. Contact force technology has also been reported to reduce the fluoroscopic time effectively 12 13.…”

Section: Discussionmentioning

confidence: 99%

Reducing radiation exposure during atrial fibrillation ablation using lectures to promote awareness

et al. 2019

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ObjectiveRecently, concern has increased regarding the hazards of radiation exposure in patients and laboratory staff. Since the numbers of complex catheter ablations (CA) performed, duration of procedure times, and need for multiple sessions have increased, radiation exposure during each session needs to be minimised. Our study aimed to assess the impact of awareness on radiation exposure during CA for atrial fibrillation (AF).MethodsMini-course lectures was delivered to the physicians and staff in the electrophysiology division. Its effect on the fluoroscopic time and radiation dose during AF ablation before (Group I, n=70), shortly after (Group II: n=70) and remotely after the mini-lecture (Group III, n=70) were evaluated. Patient demographics, preoperative testing and procedural parameters were collected.ResultsThe fluoroscopic time significantly reduced after the lecture (Group I and II: 25.1±10.0 and 15.1±7.3 min, respectively (p<0.0001)), and remained so in Group III (13.0±5.4 min), despite the increase in the number of persistent AFs. The radiation dose also significantly reduced (Groups I, II, III: 295.0±263.0, 109.6±103.5 and 110.1±89.6 mGy, respectively (p<0.0001)).ConclusionAwareness on radiation exposure led to a significant reduction in fluoroscopic time and radiation dose during CA for AF, the effect of which persisted even to remote periods following the procedure.

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Section: Discussionmentioning

confidence: 99%

Reducing radiation exposure during atrial fibrillation ablation using lectures to promote awareness

et al. 2019

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“…In our Ice&ICE Trial [11], which has investigated the feasibility of zero-fluoroscopy cryothermal ablation (CA) of the slow pathway guided by ICE navigation of the electrophysiology (EP) catheters, we included consecutive patients with documented and/or typical clinical manifestation of supraventricular tachycardia suggesting AVNRT after giving their written informed consent. The prospectively collected clinical and electrophysiological data of these patients were retrospectively compared to those of consecutive patients, who underwent fluoroscopy guided CA of the slow pathway during the last 2 years in our institution.…”

Section: Methodsmentioning

confidence: 99%

“…We described the ICE guided navigation of the EP catheters previously in detail [11]. Shortly, a two- (8F) or three-dimensional (10F) ICE catheter was introduced through an appropriate sheath to visualize endovascular and endocardial borders and help the navigation of the EP catheters within these structures (see Additional file 1: Clip S1 and Additional file 2: Clip S2 for illustration).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, we reported the feasibility of a new zero-fluoropscopy approach for slow pathway ablation in symptomatic AVNRT patients using solely two- or three-dimensional intracardiac echocardiography (ICE) for catheter navigation [11]. Potential advantages of this technique over 3D EAM could be the real-time visualization of true endovascular borders (including duplex mediated blood flow direction), endocardial structures and diagnostic or ablation catheters, as well as immediate recognition of potential complications (such as pericardial effusion or thrombus formation).…”

Section: Introductionmentioning

confidence: 99%

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

Luani

Rauwolf

Genz

et al. 2019

Cardiovasc Ultrasound

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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.

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“…Although, the 3D-mapping technology and intracardiac ultrasound can accurately visualize anatomical structures related to the TK [6,7], these methods are costly and limited to a few centers, which make the use of traditional 2D-fluoroscope-guided ablation preferable in many centers. Thus, revisiting and optimizing traditional methods for imaging the TK may result in more accurate and individualized fluoroscope imaging approaches to overcome the influence caused by anatomical variability of the TK on procedural success.…”

Section: Introductionmentioning

confidence: 99%

Revisiting right anterior oblique projections for the triangle of Koch: implications from computed tomography

Wang

Lin

Lakin

et al. 2020

BMC Cardiovasc Disord

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Background: Variability in the anatomy and orientation of the triangle of Koch (TK) complicates ablation procedures involving the atrioventricular (AV) node. We used CT angiography (CTA) to assess the anatomical TK orientation, the CS ostium direction, and the relationship between the two, and we validated an individualized CSguided projection during ablation procedures. Methods: In 104 patients without structural heart disease undergoing computed tomography (CT) angiography, TK orientations were determined in relation to the coronary sinus ostium (CSo) as well as two standard right anterior oblique (RAO) projection angles (30 o and 45 o) commonly used in ablation procedures. Results: A CS-guided RAO projection (RAOCS) was shown to best track the orientation of the TK compared to RAO30°and 45°, with TK orientation strongly correlating with the CSo direction (r = 0.86, P < 0.001). In addition, the mean relative difference between the angle of the CSo and TK orientation was 5.54 ± 0.48°, consistent with a reduction in the degree of image shortening compared to traditional RAOs. Moreover, in vivo validation following ablation revealed that using a CS-guided projection limited the degree of on-screen image shortening compared to both the RAO30°and 45°in 25 patients with catheter ablation procedures. Conclusion: In hearts with a normal structure, the CSo direction offers a reliable predictor of the TK orientation which can be used to guide the projection of the TK during ablation procedures.

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Zero‐fluoroscopy cryothermal ablation of atrioventricular nodal re‐entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial)

Cited by 16 publications

References 26 publications

Reducing radiation exposure during atrial fibrillation ablation using lectures to promote awareness

Reducing radiation exposure during atrial fibrillation ablation using lectures to promote awareness

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

Revisiting right anterior oblique projections for the triangle of Koch: implications from computed tomography

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