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Vernemmen I, Buschmann E, Demeyere M, Verhaeghe L, Van Steenkiste G, Decloedt A, van Loon G. Feasibility of transthoracic echocardiographic guidance for multicatheter electrophysiological mapping studies in horses. J Vet Intern Med 2024; 38:2686-2697. [PMID: 39096119 PMCID: PMC11423469 DOI: 10.1111/jvim.17156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Improved characterization of arrhythmias is based on minimally invasive catheterizations. However, these catheterizations have been poorly explored in horses because apart from 3-dimensional (3D) mapping systems, continuous guidance of the catheter's position with adequate detail is difficult using current imaging modalities. HYPOTHESIS Position multiple electrophysiology catheters simultaneously at predetermined strategical positions in the heart using transthoracic echocardiographic guidance. ANIMALS Eight adult healthy horses. METHODS Observational study. Two electrophysiological studies were performed: 1 procedure with catheters positioned in the right heart in the standing sedated horse and 1 procedure under general anesthesia with catheters positioned in the left heart. Except for the coronary sinus catheter, each catheter positioning was simultaneously guided by right-parasternal transthoracic echocardiography and 3D electro-anatomical mapping. RESULTS For each catheter position, a central imaging plane was taken as the starting point, after which the imaging probe was shifted, rotated, and angulated to visualize the catheter over its entire length, including its distal electrode. Catheter positionings in the right heart and left ventricle were successfully guided in the majority of the horses whereas catheter positionings in the left atrium, and especially the pulmonary veins, were challenging to guide echocardiographically. CONCLUSIONS AND CLINICAL IMPORTANCE Ultrasound guidance of catheters to specific positions useful for electrophysiological mapping was feasible in the right heart and left ventricle but challenging for the left atrium. This approach creates a perspective for minimally invasive arrhythmia diagnosis without the need for a 3D mapping system. Left parasternal views and intracardiac echocardiography might provide better guidance for left atrial positions.
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Affiliation(s)
- Ingrid Vernemmen
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - Marie Demeyere
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - Lize‐Maria Verhaeghe
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
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2
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Ding X, Xiang K, Qian C, Hou X, Wu F. Intracardiac echocardiography is a promising strategy for guiding closure of the left atrial appendage. Health Sci Rep 2023; 6:e1762. [PMID: 38116174 PMCID: PMC10728371 DOI: 10.1002/hsr2.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Background and Aims Percutaneous transcatheter left atrial appendage (LAA) closure (LAAC) is an effective approach for preventing ischemic stroke in nonvalvular atrial fibrillation patients. Intracardiac echocardiography (ICE), a new imaging modality, is a promising strategy for guiding LAAC. This review highlights the various strategies for ICE-guided-LAAC as an option for clinical policy. Methods A comprehensive literature search was conducted of PubMed, ScienceDirect, Ovid Web of Science, SpringerLink, and other notable databases to identify recent peer-reviewed clinical trials, reviews, and research articles related to ICE and its application in the guidance of LAAC. Results Various methods are used to evaluate the spatial structure and dimensions of the LAA. The main techniques for guiding LAAC are transesophageal echocardiography (TEE), cardiac computed tomography (CTA), and ICE. Among these techniques, the advantages of ICE typically include (1) multiangle and real-time assessment of intracardiac structure, (2) a reduction in procedural fluoroscopy, (3) reduced operation time and improved workflow in the catheterization laboratory, and (4) the avoidance of general anesthesia and the early detection of complications. Conclusion ICE is a promising strategy for the guidance of LAAC. Among the most advanced and recent technological innovations in cardiovascular imaging in general and volume imaging in particular, ICE offers greater efficacy and safety.
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Affiliation(s)
- Xueyan Ding
- Department of CardiologySir Run Run Shaw Hospital Zhejiang University School of MedicineHangzhouZhejiangP.R. China
| | - Kefa Xiang
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
| | - Congli Qian
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
| | - Xu Hou
- Bengbu Medical CollegeBengbuAnhuiP.R. China
| | - Feng Wu
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
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3
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Jingquan Z, Deyong L, Huimin C, Hua F, Xuebin H, Chenyang J, Yan L, Xuebin L, Min T, Zulu W, Yumei X, Jinlin Z, Wei Z, Xiaochun Z, Daxin Z, Yun Z, Changsheng M, Zei PC, Di Biase L. Intracardiac echocardiography Chinese expert consensus. Front Cardiovasc Med 2022; 9:1012731. [PMID: 36277762 PMCID: PMC9584059 DOI: 10.3389/fcvm.2022.1012731] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, percutaneous catheter interventions have continuously evolved, becoming an essential strategy for interventional diagnosis and treatment of many structural heart diseases and arrhythmias. Along with the increasing complexity of cardiac interventions comes ever more complex demands for intraoperative imaging. Intracardiac echocardiography (ICE) is well-suited for these requirements with real-time imaging, real-time monitoring for intraoperative complications, and a well-tolerated procedure. As a result, ICE is increasingly used many types of cardiac interventions. Given the lack of relevant guidelines at home and abroad and to promote and standardize the clinical applications of ICE, the members of this panel extensively evaluated relevant research findings, and they developed this consensus document after discussions and correlation with front-line clinical work experience, aiming to provide guidance for clinicians and to further improve interventional cardiovascular diagnosis and treatment procedures.
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Affiliation(s)
- Zhong Jingquan
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China,*Correspondence: Zhong Jingquan,
| | - Long Deyong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China,Long Deyong,
| | - Chu Huimin
- Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Fu Hua
- West China Hospital, Sichuan University, Chengdu, China
| | - Han Xuebin
- The Affiliated Cardiovascular Hospital, Shanxi Medical University, Taiyuan, China
| | - Jiang Chenyang
- Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Li Yan
- Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Li Xuebin
- Peking University People’s Hospital, Beijing, China
| | - Tang Min
- Fuwai Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang Zulu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Xue Yumei
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | | | - Zhang Wei
- Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | | | - Zhou Daxin
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhang Yun
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ma Changsheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Paul C. Zei
- Brigham and Women’s Hospital, Boston, MA, United States
| | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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4
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Pimentel RC, Rahai N, Maccioni S, Khanna R. DIFFERENCES IN OUTCOMES AMONG PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING CATHETER ABLATION WITH VERSUS WITHOUT INTRACARDIAC ECHOCARDIOGRAPHY. J Cardiovasc Electrophysiol 2022; 33:2015-2047. [PMID: 35711034 PMCID: PMC9544828 DOI: 10.1111/jce.15599] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/18/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
Background Intracardiac echocardiography (ICE) use can lead to early detection of periprocedural complications and may improve patient outcomes by providing real‐time visualization of catheter location and the treatment area during cardiac ablation (CA) for atrial fibrillation (AF). Objective Examine complications and 12‐month healthcare use among patients with AF undergoing CA with versus without ICE use during the procedure in a real‐world setting. Methods The 2015–2020 IBM MarketScan® Database was used to identify non‐elderly adults (age 18–64 years) undergoing CA for AF. Patients were classified into ICE/non‐ICE groups based on the presence or absence of ICE procedure codes. Patients in each group were matched on study covariates using propensity scores. Peri‐procedural complications, 12‐month cardiovascular (CV) or AF‐related inpatient admission, repeat CA, and cardioversion were compared using a Cox proportional hazard model. Results 1371 patients were identified in each study cohort (ICE and non‐ICE) after propensity matching. Patients who had CA with ICE had a significantly lower rate of complications than those without (2.9% vs. 5.8%; p < .001). The risk of complications was 50% lower with ICE use (hazard ratio [HR] 0.50; 95% confidence interval [CI] 0.34–0.72). For assessment of 12‐month healthcare utilization, 1250 patients were identified in each cohort after propensity matching. ICE use was associated with a 36% lower risk of 12‐month repeat ablation (HR 0.64; 95% CI 0.49–0.83). No differences in CV‐ or AF‐related inpatient admission and cardioversion were observed. Conclusion Among patients with AF, the use of ICE during an ablation procedure was associated with lower incidence of complications and repeat ablation.
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Affiliation(s)
- R C Pimentel
- The University of Kansas Health System, Kansas City, KS, USA
| | - N Rahai
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | - S Maccioni
- Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, CA, USA
| | - R Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
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5
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Xu J, Gao Y, Liu C, Wang Y. Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography vs without intracardiac echocardiography: A meta-analysis of observational and randomized studies. J Cardiovasc Electrophysiol 2022; 33:897-907. [PMID: 35212079 DOI: 10.1111/jce.15423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIMS Intracardiac echocardiography (ICE) provides superior quality images and can monitor catheter location within the heart continuously. Given the limited evidence, we conducted the meta-analysis to evaluate outcomes with ICE in radiofrequency (RF) ablation of atrial fibrillation (AF). METHODS AND RESULTS PubMed/MEDLINE, Embase and Cochrane were searched for studies reporting RF ablation for treatment of AF with the use of ICE vs without ICE and 12 studies were included. Sensitivity analyses limiting studies to ablation with the use of contact force (CF) catheters were conducted and subgroup analyses were performed according to the published year. In main analyses, RF ablation with ICE for treatment of AF was associated with significant reduction in total X-ray time (MD, -9.80; 95% CI, -15.57 to -4.04; I2 =99%; p <0.01), total procedure time (MD, -17.65; 95% CI, -30.22 to -5.09; I2 =89%; p <0.01), and complications (RR, 0.90; 95% CI, 0.87 to 0.92; I2 =20%; p<0.01) vs without ICE. The ICE-guided group tended to decrease total absorbed X-ray dose (SMD, -0.91; 95% CI, -1.86 to 0.04; I2 =96%; p =0.06). Freedom from arrhythmia (RR, 1.06; 95% CI, 0.98 to 1.14; I2 =0%; p =0.13) was comparable between the two groups. CONCLUSION In patients with AF, ICE-guided RF ablation is correlated with significant reductions in total X-ray time, total procedure time, and complications vs ablation without ICE. Total absorbed X-ray dose tends to reduce in the ICE group and freedom from arrhythmia is comparable between the two groups. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jingmiao Xu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Ying Gao
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Chunhui Liu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
| | - Yaping Wang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cardiovascular Key Lab of Zhejiang Province, Hangzhou, China
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6
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Campbell T, Haqqani H, Kumar S. Intracardiac Echocardiography to Guide Mapping and Ablation of Arrhythmias in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2021; 13:345-356. [PMID: 33990273 DOI: 10.1016/j.ccep.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Catheter ablation of arrhythmias in congenital heart disease can be a challenging undertaking with often complicated anatomic considerations. Understanding this anatomy and the prior surgical repairs is key to procedural planning and a successful outcome. Intracardiac echocardiography (ICE) adds complimentary real-time visualization of anatomy and catheter positioning along with other imaging modalities. In addition, ICE can visualize suture lines, baffles, and conduits from repaired congenital heart disease and forms a useful part of the toolkit required to deal with these complex arrhythmias.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Haris Haqqani
- Prince Charles Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia.
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7
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Al Asmar M, Houssari M, Carlos El-Tallawi K, Feghali T, Refaat M, Khoury M, Abi-Saleh B. Safety of mapping in the sinus of valsalva region under intracardiac echocardiography guidance without angiography. Indian Pacing Electrophysiol J 2021; 21:141-144. [PMID: 33571656 PMCID: PMC8116810 DOI: 10.1016/j.ipej.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Radiofrequency ablation at the region of the sinus of Valsalva carries a risk to the ostia of the coronary arteries. Coronary angiography is usually utilized to document a safe distance for mapping and ablation. Objective To show that catheter ablation in the aortic root could be guided by phased-array intra cardiac echocardiography (ICE) and electro anatomic mapping without the need for coronary angiography. Methods We reviewed all patients referred to our lab that underwent mapping and/or ablation in the sinus of Valsalva region. Procedures were carried out by operators that are skilled in the use of ICE. The need for angiography was documented, also the rate of success along with the immediate and 30-day complications rate. Results Seventy patients (average age 48.7 ± 13.8 years; 64.3% males) were referred for ablation of ventricular and atrial arrhythmias. PVC constituted 95.7% of the cases. All patients underwent mapping and/or ablation at the sinus of Valsalva region without the need for coronary angiography to visualize the coronary ostia. Acute and effective ablation was achieved in 57 out of 70 (81.4%) patients partially effective ablation was achieved in 10 (14.3%) patients, and failure to ablate in the remaining 3 patients (4.3%). There was no occurrence of any adverse events, neither immediately or at day 30 after the procedure. Conclusion In the hands of experienced operators, mapping and radiofrequency ablation in the sinus of Valsalva can be safely and reliably performed using intracardiac echocardiography alone without the need for supplementary catheter coronary angiography.
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Affiliation(s)
- Mike Al Asmar
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Toufic Feghali
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan Refaat
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Maurice Khoury
- American University of Beirut Medical Center, Beirut, Lebanon
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8
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Le Bloa M, Abadir S, Nair K, Mondésert B, Khairy P. New developments in catheter ablation for patients with congenital heart disease. Expert Rev Cardiovasc Ther 2020; 19:15-26. [PMID: 33153326 DOI: 10.1080/14779072.2021.1847082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material. Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges. Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.
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Affiliation(s)
- Mathieu Le Bloa
- Montreal Heart Institute, Université De Montréal , Montreal, Canada.,Electrophysiology Service, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
| | - Sylvia Abadir
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
| | - Krishnakumar Nair
- University Health Network, Toronto General Hospital , Toronto, Canada
| | | | - Paul Khairy
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
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9
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Kella DK, Yasin OZ, Isath AM, McLeod CJ, Canon B, Asirvatham SJ, Wackel PL. Radiofrequency ablation of the cavotricuspid isthmus for management of atrial flutter in patients with congenital heart disease after tricuspid valve surgery: A single-center experience. Heart Rhythm 2019; 16:1621-1628. [DOI: 10.1016/j.hrthm.2019.04.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Indexed: 11/28/2022]
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10
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Agarwal S, Tahir Janjua MS, Singh P, Odo N, Castresana MR. Iatrogenic atrio-esophageal fistula following a video-assisted thoracoscopic maze procedure: Is esophageal instrumentation justified even when the diagnosis is equivocal? Ann Card Anaesth 2018; 21:208-211. [PMID: 29652289 PMCID: PMC5914228 DOI: 10.4103/aca.aca_133_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 74-year-old female underwent an uneventful bilateral thoracoscopic maze procedure for persistent atrial fibrillation with continuous transesophageal echocardiographic (TEE) guidance. She presented six weeks later with persistent fever and focal neurological signs. Computed tomography of the thorax revealed air in the posterior LA, raising suspicion for an abscess versus an atrioesophageal fistula (AEF). Before undergoing an exploratory median sternotomy, an esophagogastroduodenoscopy (EGD) was performed by the surgeon to check for any esophageal pathology. This however, resulted in sudden hemodynamic compromise that required intensive treatment with vasopressors and inotropes. In this case-report, we review the various intraoperative risk factors associated with the development of AEF during cardiac ablation procedures as well as the potential hazards of esophageal instrumentation with TEE, naso- or oro- gastric devices, and/or an EGD when an AEF is suspected.
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Affiliation(s)
- Shvetank Agarwal
- Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, GA, USA
| | | | - Paramvir Singh
- Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, GA, USA
| | - Nadine Odo
- Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, GA, USA
| | - Manuel R Castresana
- Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, GA, USA
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11
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Ciske BR, Speidel MA, Raval AN. Improving the cardiac cath-lab interventional imaging eco-system. Transl Pediatr 2018; 7:1-4. [PMID: 29441275 PMCID: PMC5803015 DOI: 10.21037/tp.2017.09.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Benjamin R Ciske
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Michael A Speidel
- Department of Medicine, University of Wisconsin, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Amish N Raval
- Department of Medicine, University of Wisconsin, Madison, WI, USA
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12
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Graham AJ, Orini M, Lambiase PD. Limitations and Challenges in Mapping Ventricular Tachycardia: New Technologies and Future Directions. Arrhythm Electrophysiol Rev 2017; 6:118-124. [PMID: 29018519 DOI: 10.15420/aer.2017.20.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recurrent episodes of ventricular tachycardia in patients with structural heart disease are associated with increased mortality and morbidity, despite the life-saving benefits of implantable cardiac defibrillators. Reducing implantable cardiac defibrillator therapies is important, as recurrent shocks can cause increased myocardial damage and stunning, despite the conversion of ventricular tachycardia/ventricular fibrillation. Catheter ablation has emerged as a potential therapeutic option either for primary or secondary prevention of these arrhythmias, particularly in post-myocardial infarction cases where the substrate is well defined. However, the outcomes of catheter ablation of ventricular tachycardia in structural heart disease remain unsatisfactory in comparison with other electrophysiological procedures. The disappointing efficacy of ventricular tachycardia ablation in structural heart disease is multifactorial. In this review, we discuss the issues surrounding this and examine the limitations of current mapping approaches, as well as newer technologies that might help address them.
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Affiliation(s)
| | - Michele Orini
- Barts Heart Centre, London.,Institute of Cardiovascular Science, UCL, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, London.,Institute of Cardiovascular Science, UCL, London, United Kingdom
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13
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Wildes D, Lee W, Haider B, Cogan S, Sundaresan K, Mills DM, Yetter C, Hart PH, Haun CR, Concepcion M, Kirkhorn J, Bitoun M. 4-D ICE: A 2-D Array Transducer With Integrated ASIC in a 10-Fr Catheter for Real-Time 3-D Intracardiac Echocardiography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2016; 63:2159-2173. [PMID: 27740477 DOI: 10.1109/tuffc.2016.2615602] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We developed a 2.5 ×6.6 mm 2 2 -D array transducer with integrated transmit/receive application-specific integrated circuit (ASIC) for real-time 3-D intracardiac echocardiography (4-D ICE) applications. The ASIC and transducer design were optimized so that the high-voltage transmit, low-voltage time-gain control and preamp, subaperture beamformer, and digital control circuits for each transducer element all fit within the 0.019-mm 2 area of the element. The transducer assembly was deployed in a 10-Fr (3.3-mm diameter) catheter, integrated with a GE Vivid E9 ultrasound imaging system, and evaluated in three preclinical studies. The 2-D image quality and imaging modes were comparable to commercial 2-D ICE catheters. The 4-D field of view was at least 90 ° ×60 ° ×8 cm and could be imaged at 30 vol/s, sufficient to visualize cardiac anatomy and other diagnostic and therapy catheters. 4-D ICE should significantly reduce X-ray fluoroscopy use and dose during electrophysiology ablation procedures. 4-D ICE may be able to replace transesophageal echocardiography (TEE), and the associated risks and costs of general anesthesia, for guidance of some structural heart procedures.
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14
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Bhaskaran A, Chik W, Thomas S, Kovoor P, Thiagalingam A. A review of the safety aspects of radio frequency ablation. IJC HEART & VASCULATURE 2015; 8:147-153. [PMID: 28785694 PMCID: PMC5497290 DOI: 10.1016/j.ijcha.2015.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/03/2022]
Abstract
In light of recent reports showing high incidence of silent cerebral infarcts and organized atrial arrhythmias following radiofrequency (RF) atrial fibrillation (AF) ablation, a review of its safety aspects is timely. Serious complications do occur during supraventricular tachycardia (SVT) ablations and knowledge of their incidence is important when deciding whether to proceed with ablation. Evidence is emerging for the probable role of prophylactic ischemic scar ablation to prevent VT. This might increase the number of procedures performed. Here we look at the various complications of RF ablation and also the methods to minimize them. Electronic database was searched for relevant articles from 1990 to 2015. With better awareness and technological advancements in RF ablation the incidence of complications has improved considerably. In AF ablation it has decreased from 6% to less than 4% comprising of vascular complications, cardiac tamponade, stroke, phrenic nerve injury, pulmonary vein stenosis, atrio-esophageal fistula (AEF) and death. Safety of SVT ablation has also improved with less than 1% incidence of AV node injury in AVNRT ablation. In VT ablation the incidence of major complications was 5-11%, up to 3.4%, up to 1.8% and 4.1-8.8% in patients with structural heart disease, without structural heart disease, prophylactic ablations and epicardial ablations respectively. Vascular and pericardial complications dominated endocardial and epicardial VT ablations respectively. Up to 3% mortality and similar rates of tamponade were reported in endocardial VT ablation. Recent reports about the high incidence of asymptomatic cerebral embolism during AF ablation are concerning, warranting more research into its etiology and prevention.
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Affiliation(s)
- Abhishek Bhaskaran
- Corresponding author at: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
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Hannawa KK, Good ED, Haft JW, Williams DM. Percutaneous Extraction of Embolized Intracardiac Inferior Vena Cava Filter Struts Using Fused Intracardiac Ultrasound and Electroanatomic Mapping. J Vasc Interv Radiol 2015; 26:1368-74. [DOI: 10.1016/j.jvir.2015.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 02/02/2023] Open
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16
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Detection of left atrial thrombus by intracardiac echocardiography in patients undergoing ablation of atrial fibrillation. J Interv Card Electrophysiol 2015; 43:227-36. [DOI: 10.1007/s10840-015-0008-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/06/2015] [Indexed: 01/30/2023]
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17
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Determination of left atrium volume by fast anatomical mapping and intracardiac echocardiography. The contribution of respiratory gating. J Interv Card Electrophysiol 2015; 42:129-34. [DOI: 10.1007/s10840-014-9968-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/22/2014] [Indexed: 01/22/2023]
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18
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Dello Russo A, Conti S, Al-Mohani G, Casella M, Pizzamiglio F, Carbucicchio C, Riva S, Fassini G, Moltrasio M, Tundo F, Zucchetti M, Majocchi B, Russo E, Marino V, Bologna F, Biase LD, Natale A, Tondo C. New Imaging Technologies To Characterize Arrhythmic Substrate. J Atr Fibrillation 2014; 7:1137. [PMID: 27957131 DOI: 10.4022/jafib.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/09/2014] [Accepted: 10/27/2014] [Indexed: 11/10/2022]
Abstract
The cornerstone of the new imaging technologies to treat complex arrhythmias is the electroanatomic (EAM) mapping. It is based on tissue characterization and in particular on determination of low potential region and dense scar definition. Recently, the identification of fractionated isolated late potentials increased the specificity of the information derived from EAM. In addition, non-invasive tools and their integration with EAM, such as cardiac magnetic resonance imaging and computed tomography scanning, have been shown to be helpful to characterize the arrhythmic substrate and to guide the mapping and the ablation. Finally, intracardiac echocardiography, known to be useful for several practical uses in the setting of electrophysiological procedures, it has been also demonstrated to provide important informations about the anatomical substrate and may have potential to identify areas of scarred myocardium.
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Affiliation(s)
- Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Sergio Conti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Ghaliah Al-Mohani
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Francesca Pizzamiglio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Gaetano Fassini
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Massimo Moltrasio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Fabrizio Tundo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Benedetta Majocchi
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Vittoria Marino
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Fabrizio Bologna
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Luigi Di Biase
- St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Andrea Natale
- St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
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Nicoara A, Holmquist F, Raggains C, Mathew JP. Anesthesia for Catheter Ablation Procedures. J Cardiothorac Vasc Anesth 2014; 28:1589-603. [DOI: 10.1053/j.jvca.2014.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Indexed: 11/11/2022]
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20
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Dausch DE, Gilchrist KH, Carlson JB, Hall SD, Castellucci JB, von Ramm OT. In vivo real-time 3-D intracardiac echo using PMUT arrays. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2014; 61:1754-64. [PMID: 25265183 DOI: 10.1109/tuffc.2014.006452] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Piezoelectric micromachined ultrasound transducer (PMUT) matrix arrays were fabricated containing novel through-silicon interconnects and integrated into intracardiac catheters for in vivo real-time 3-D imaging. PMUT arrays with rectangular apertures containing 256 and 512 active elements were fabricated and operated at 5 MHz. The arrays were bulk micromachined in silicon-on-insulator substrates, and contained flexural unimorph membranes comprising the device silicon, lead zirconate titanate (PZT), and electrode layers. Through-silicon interconnects were fabricated by depositing a thin-film conformal copper layer in the bulk micromachined via under each PMUT membrane and photolithographically patterning this copper layer on the back of the substrate to facilitate contact with the individually addressable matrix array elements. Cable assemblies containing insulated 45-AWG copper wires and a termination silicon substrate were thermocompression bonded to the PMUT substrate for signal wire interconnection to the PMUT array. Side-viewing 14-Fr catheters were fabricated and introduced through the femoral vein in an adult porcine model. Real-time 3-D images were acquired from the right atrium using a prototype ultrasound scanner. Full 60° × 60° volume sectors were obtained with penetration depth of 8 to 10 cm at frame rates of 26 to 31 volumes per second.
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Abstract
Late after surgical repair of complex congenital heart disease, atrial arrhythmias are a major cause of morbidity, and ventricular arrhythmias and sudden cardiac death are a major cause of mortality. The six cases in this article highlight common challenges in the management of arrhythmias in the adult congenital heart disease population.
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Affiliation(s)
- Robert M Hayward
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
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Filgueiras-Rama D, de Torres-Alba F, Castrejón-Castrejón S, Estrada A, Figueroa J, Salvador-Montañés Ó, López T, Moreno-Yanguela M, López Sendón JL, Merino JL. Utility of intracardiac echocardiography for catheter ablation of complex cardiac arrhythmias in a medium-volume training center. Echocardiography 2014; 32:660-70. [PMID: 25109241 DOI: 10.1111/echo.12714] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS AND OBJECTIVES New electrophysiology tools like intracardiac echocardiography (ICE) might help to minimize and early detect complications during cardiac ablation procedures. The aim of the study was to assess the utility and vascular safety of ICE during catheter ablation of complex cardiac arrhythmias in a medium-volume training center. METHODS Prospective, observational study consisted of consecutive patients who underwent catheter-based ablation of complex cardiac arrhythmias. All procedures were performed using three-dimensional electro-anatomical mapping and routine cannulation of right and left femoral veins. The ICE probe was initially positioned at the mid-level of the right atrium and properly moved to monitor different steps of the procedure and identify complications. All procedure-related vascular complications were registered. RESULTS One hundred two patients (age 61.4 ± 13.1 years, 69 male) underwent 110 ablation procedures. Pulmonary vein isolation was the most common ablation substrate (55.4%). Ventricular tachycardia (17.2%) and left atrial flutter procedures (16.4%) were also common. The use of ICE enabled us to early initiate anticoagulation and to optimize the transseptal puncture. It also provided the capability to early detect life-threatening complications such as tamponade (3.6%), along with important information during the procedure such as exact catheter location, lesion formation, and stability during radiofrequency delivery. Such benefits were not associated with a higher number of vascular complications. CONCLUSION The use of ICE during catheter-based ablation of complex cardiac substrates provides technical features that may decrease complications and increase accuracy while applying radiofrequency, especially in training centers where fellows start to perform complex procedures.
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Affiliation(s)
- David Filgueiras-Rama
- Department of Cardiology, La Paz University Hospital, Madrid, Spain; Atherothrombosis, Imaging and Epidemiology Department, National Center for Cardiovascular Research (CNIC), Madrid, Spain
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23
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Haines DE, Beheiry S, Akar JG, Baker JL, Beinborn D, Beshai JF, Brysiewicz N, Chiu-Man C, Collins KK, Dare M, Fetterly K, Fisher JD, Hongo R, Irefin S, Lopez J, Miller JM, Perry JC, Slotwiner DJ, Tomassoni GF, Weiss E. Heart Rythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety. Heart Rhythm 2014; 11:e9-51. [PMID: 24814989 PMCID: PMC7106221 DOI: 10.1016/j.hrthm.2014.03.042] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Indexed: 01/08/2023]
Affiliation(s)
| | - Salwa Beheiry
- California Pacific Medical Center, San Francisco, California
| | - Joseph G. Akar
- Yale University School of Medicine, New Haven Connecticut
| | | | | | | | | | | | | | | | | | | | - Richard Hongo
- Sutter Pacific Medical Foundation, San Francisco, California
| | | | | | - John M. Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - David J. Slotwiner
- Hofstra School of Medicine, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Sherwin ED, Triedman JK, Walsh EP. Update on interventional electrophysiology in congenital heart disease: evolving solutions for complex hearts. Circ Arrhythm Electrophysiol 2013; 6:1032-40. [PMID: 24129205 DOI: 10.1161/circep.113.000313] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Elizabeth D Sherwin
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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25
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Baran J, Stec S, Pilichowska-Paszkiet E, Zaborska B, Sikora-Frąc M, Kryński T, Michałowska I, Łopatka R, Kułakowski P. Intracardiac Echocardiography for Detection of Thrombus in the Left Atrial Appendage. Circ Arrhythm Electrophysiol 2013; 6:1074-81. [DOI: 10.1161/circep.113.000504] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jakub Baran
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Sebastian Stec
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Ewa Pilichowska-Paszkiet
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Beata Zaborska
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Małgorzata Sikora-Frąc
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Tomasz Kryński
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Ilona Michałowska
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Rafał Łopatka
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Piotr Kułakowski
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
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Hussein A, Jimenez A, Ahmad G, Mesubi O, Klein T, Gurm G, Beck H, Shams O, See V, Saliaris A, Shorofsky S, Dickfeld T. Assessment of ventricular tachycardia scar substrate by intracardiac echocardiography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:412-21. [PMID: 24164545 DOI: 10.1111/pace.12278] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/30/2013] [Accepted: 09/02/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is increasingly used to guide complex ablation procedures. This study aimed to assess the scar substrate of ventricular tachycardia (VT) by ICE in patients undergoing VT ablation. METHODS In 22 patients undergoing VT ablation (10 ischemic, 12 nonischemic), the Biosense CARTOSOUND module (Biosense Webster, Diamond Bar, CA, USA) was used for three-dimensional reconstruction of the ventricles. The characteristics and appearance with ICE imaging of voltage-defined scar zones (bipolar voltage <0.5 mV), border zones (0.5-1.5 mV), and normal myocardium (>1.5 mV) on electroanatomic maps were evaluated. The standard image analysis software Image J (National Institutes of Health, Bethesda, MD, USA) was used to analyze signal intensity (mean pixel signal intensity unit [SIU]) and heterogeneity (standard deviation of signal intensity in analyzed area) on ICE images. RESULTS A total of 83 myocardial areas were analyzed from two-dimensional ICE images (15 scars, 31 border zones, and 37 normal). Voltage-defined scar zones had increased signal intensities compared to border zones (149 SIU vs 104 SIU, P < 0.0001) and normal myocardium (88 SIU, P < 0.0001). Border zones were more likely to have heterogeneous densities compared to normal myocardium (standard deviation of signal intensity 20 SIU vs 12 SIU, P < 0.0001). In receiver-operator characteristic analyses, signal intensity ≥ 137 SIU differentiated scar from nonscar zones (area under curve 0.91, P < 0.0001). Software-based color enhancement of areas with signal intensity ≥ 137 SIU allowed identification of the VT substrate in all 15 patients with voltage-defined scar zones. CONCLUSIONS ICE provides important information about the VT anatomical substrate and may have potential to identify areas of scarred myocardium.
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Affiliation(s)
- Ayman Hussein
- From the Division of Cardiology, Maryland Arrhythmia and Cardiology Imaging Group (MACIG), University of Maryland, Baltimore, Maryland
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Abstract
Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. Intracardiac echocardiography (ICE) complements and has in part replaced transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging. The latter is still widely accepted as a method to prepare for and to guide interventional treatments. In contrast to TEE, ICE represents a purely intraprocedural guiding and imaging tool unsuitable for diagnostic purposes. Patients tolerate ICE much better, and the method does not require general anaesthesia. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications. This review describes the peri-interventional role of ICE, outlines current limitations, and points out future implications. Two-dimensional ICE has become a suitable guiding tool for a variety of percutaneous treatments in patients who are conscious or under monitored anaesthesia care, whereas RT-3DICE is still undergoing clinical testing. Continuous TEE monitoring under general anaesthesia remains a widely accepted alternative.
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Affiliation(s)
- Thomas Bartel
- Division of Cardiology, Department of Internal Medicine III, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
- Corresponding author. Tel: +43 512 50481992, Fax: +43 512 50423379,
| | - Silvana Müller
- Division of Cardiology, Department of Internal Medicine III, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Angelo Biviano
- Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, USA
| | - Rebecca T. Hahn
- Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, USA
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Brooks AG, Wilson L, Chia NH, Lau DH, Alasady M, Leong DP, Laborderie J, Roberts-Thomson KC, Young GD, Kalman JM, Sanders P. Accuracy and clinical outcomes of CT image integration with Carto-Sound compared to electro-anatomical mapping for atrial fibrillation ablation: A randomized controlled study. Int J Cardiol 2013; 168:2774-82. [DOI: 10.1016/j.ijcard.2013.03.130] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/19/2013] [Accepted: 03/26/2013] [Indexed: 11/28/2022]
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Chenier M, Tuzcu EM, Kapadia SR, Krishnaswamy A. Multimodality imaging in the cardiac catheterization laboratory: a new era in sight. Interv Cardiol 2013. [DOI: 10.2217/ica.13.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Dello Russo A, Russo E, Fassini G, Casella M, Innocenti E, Zucchetti M, Cefalu C, Solimene F, Mottola G, Colombo D, Bologna F, Majocchi B, Santangeli P, Riva S, Di Biase L, Fiorentini C, Tondo C. Role of Intracardiac echocardiography in Atrial Fibrillation Ablation. J Atr Fibrillation 2013; 5:786. [PMID: 28496830 DOI: 10.4022/jafib.786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/27/2013] [Accepted: 03/04/2013] [Indexed: 12/18/2022]
Abstract
In the recent years, several new evidences support catheter-based ablation as a treatment modality of atrial fibrillation (AF). Based on a plenty of different applications, intracardiac echocardiography (ICE) is now a well-established technology in complex electrophysiological procedures, in particular in AF ablation. ICE contributes to improve the efficacy and safety of such procedures defining the anatomical structures involved in ablation procedures and monitoring in real time possible complications. In particular ICE allows: a correct identification of the endocardial structures; a guidance of transseptal puncture; an assessment of accurate placement of the circular mapping catheter; an indirect evaluation of evolving lesions during radiofrequency (RF) energy delivery via visualization of micro and macrobubbles tissue heating; assessment of catheter contact with cardiac tissues. Recently, also the feasibility of the integration of electroanatomical mapping (EAM) and intracardiac echocardiography has been demonstrated, combining accurate real time anatomical information with electroanatomical data. As a matter of fact, different techniques and ablation strategies have been developed throughout the years. In the setting of balloon-based ablation systems, recently adopted by an increasing number of centers, ICE might have a role in the choice of appropriate balloon size and to confirm accurate occlusion of pulmonary veins. Furthermore, in the era of minimally fluoroscopic ablation, ICE has successfully provided a contribute in reducing fluoroscopy time. The purpose of this review is to summarize the current applications of ICE in catheter based ablation strategies of atrial fibrillation, focusing-on electronically phased-array ICE.
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Affiliation(s)
- Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gaetano Fassini
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Ester Innocenti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Claudia Cefalu
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Daniele Colombo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabrizio Bologna
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Cesare Fiorentini
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
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RUISI CHRISTOPHERP, BRYSIEWICZ NEIL, ASNES JEREMYD, SUGENG LISSA, MARIEB MARK, CLANCY JUDE, AKAR JOSEPHG. Use of Intracardiac Echocardiography during Atrial Fibrillation Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:781-8. [DOI: 10.1111/pace.12030] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/02/2012] [Accepted: 08/21/2012] [Indexed: 11/30/2022]
Affiliation(s)
- CHRISTOPHER P. RUISI
- Section of Cardiovascular Medicine, Division of Medicine; Yale University School of Medicine; New Haven; Connecticut
| | - NEIL BRYSIEWICZ
- Section of Cardiovascular Medicine, Division of Medicine; Yale University School of Medicine; New Haven; Connecticut
| | - JEREMY D. ASNES
- Section of Cardiovascular Medicine, Division of Medicine; Yale University School of Medicine; New Haven; Connecticut
| | - LISSA SUGENG
- Section of Cardiovascular Medicine, Division of Medicine; Yale University School of Medicine; New Haven; Connecticut
| | - MARK MARIEB
- Section of Cardiovascular Medicine, Division of Medicine; Yale University School of Medicine; New Haven; Connecticut
| | - JUDE CLANCY
- Section of Cardiovascular Medicine, Division of Medicine; Yale University School of Medicine; New Haven; Connecticut
| | - JOSEPH G. AKAR
- Section of Cardiovascular Medicine, Division of Medicine; Yale University School of Medicine; New Haven; Connecticut
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32
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Kolandaivelu A. Role of Cardiac Imaging (CT/MR) Before and After RF Catheter Ablation in Patients with Atrial Fibrillation. J Atr Fibrillation 2012; 5:523. [PMID: 28496759 DOI: 10.4022/jafib.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/29/2012] [Accepted: 05/11/2012] [Indexed: 01/08/2023]
Abstract
Pre-procedure X-ray computed tomography (CT) and magnetic resonance imaging (MRI) angiography are commonly used to delineate the complex and variable relationship of the left atrium, pulmonary veins, and surrounding structures. 3D CT and MR angiography are routinely incorporated into electroanatomic mapping systems to guide ablation lesion placement in the context of patient specific anatomy. Post-procedure CT and MRI have also proven useful for evaluating complications such as pulmonary vein stenosis. In the future, these imaging modalities may be used to visualize more detailed tissue characteristics such as atrial fibrosis and ablation lesions. This could improve selection of patients for different treatment strategies and perhaps guide more effective ablation. This review will discuss current and emerging applications of CT and MRI before and after radiofrequency catheter ablation of atrial fibrillation.
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Affiliation(s)
- Aravindan Kolandaivelu
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, MD 21205
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33
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Link MS, Exner DV, Anderson M, Ackerman M, Al-Ahmad A, Knight BP, Markowitz SM, Kaufman ES, Haines D, Asirvatham SJ, Callans DJ, Mounsey JP, Bogun F, Narayan SM, Krahn AD, Mittal S, Singh J, Fisher JD, Chugh SS. HRS policy statement: clinical cardiac electrophysiology fellowship curriculum: update 2011. Heart Rhythm 2011; 8:1340-56. [PMID: 21699868 DOI: 10.1016/j.hrthm.2011.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Indexed: 01/29/2023]
Affiliation(s)
- Mark S Link
- Tufts Medical Center, Boston, Massachusetts, USA
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Kean AC, Gelehrter SK, Shetty I, Dick M, Bradley DJ. Experience with CartoSound for arrhythmia ablation in pediatric and congenital heart disease patients. J Interv Card Electrophysiol 2010; 29:139-45. [PMID: 20878221 DOI: 10.1007/s10840-010-9512-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 08/26/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE Electro-anatomic mapping (EAM) has been used for more than a decade to assist in defining arrhythmia propagation for transcatheter ablation. Intra-cardiac echocardiography (ICE) has also gained acceptance as an adjunct to further define intracardiac anatomy. The integration of these two technologies (CartoSound, Biosense-Webster, Diamond Bar, CA, USA) is a recent development. In this report, we describe our early experience in the young, with and without congenital heart defects (CHD). METHODS The clinical and electrophysiologic records of the first 17 patients to undergo procedures with the CartoSound (EAM-ICE) system were reviewed. In all 17, the 3-dimensional shape of the chamber(s) of interest was created using serial tracing of ICE images. The ICE catheter was placed in the esophagus in three and through the femoral vein in 14. Descriptive analysis was performed on demographic data as well as procedural characteristics including procedure time, fluoroscopy time, geometry acquisition time, EAM duration, ablation time, procedure success, and complications. RESULTS Arrhythmias comprised intra-atrial re-entry tachycardia (13 patients, 76%), Wolff-Parkinson-White syndrome (1; 6%), ventricular ectopic tachycardia (2; 12%), and atrioventricular node re-entrant tachycardia (1; 6%). Thirteen had CHD, with a median two palliative operations; six had single-ventricle anatomy. Procedure duration was 266 ± 134 min (median ± SD), and fluoroscopy time was 29 ± 28.3 min. Geometry acquisition took 41 ± 35.4 min, or 16% of the total case duration. Ablation lesions were placed in 16 cases, (cooled tip in 12) of which 15 (94%) were successful. One patient experienced mild hypotension. ICE image quality in three patients with the probe placed in the esophagus was suboptimal. CONCLUSIONS Advantages of CartoSound appear to be (1) anatomy modeling in the shape imposed by the arrhythmia, (2) more accurate geometry than EAM alone, and (3) demonstration of catheter position and lesions on echo during the study. Perceived disadvantages are (1) the large sheath required for ICE (11F), and (2) significant procedure time devoted to creation of anatomy. Optimal use may be to focus on key structures required for ablation, obtaining additional views as needed.
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Affiliation(s)
- Adam C Kean
- Michigan Congenital Heart Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5204, USA
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