Intracardiac Echocardiography to Guide Catheter Ablation of Idiopathic Ventricular Arrythmias

Impact of catheter ablation procedure on optical coherence tomography angiography findings in patients with ventricular arrhythmia

OBJECTIVE

Catheter ablation procedure may cause retinal complications associated with the risk of thromboembolism. We aimed to evaluate retina and optic disc microvascularity with optical coherence tomography angiography before and after the catheter ablation process in patients with ventricular arrhythmia.

METHODS

A total of 40 eyes of 21 ventricular arrhythmia patients were included in this cross-sectional study. Demographic characteristics and ophthalmic examination findings of patients were recorded. optical coherence tomography angiography measurements were evaluated before (group 1) and after (group 2) catheter ablation. Optical coherence tomography angiography was applied to all eyes with 6×6 mm sections for the macula and 4.5×4.5 mm sections for the optic nerve head. Foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, vessel density in different parts of the retina, and optic disc were analyzed.

RESULTS

The mean age of ventricular arrhythmia patients was 53.48±13.02 years. In all, 13 (61.9%) of the patients were males and 8 (38.1%) were females. There was no significant difference between the groups in terms of average, inferior, superior, and temporal retinal nerve fiber layer thicknesses, foveal avascular area, flow areas, superficial and deep vessel densities, and optic disc capillary densities of the optic disc. However, when compared with group 1, significantly lower values in foveal retinal thickness and higher values in nasal retinal nerve fiber layer thickness were observed in group 2 (248.42±20.50 vs. 247.20±20.44, p<0.001 and 94.22±18.43 vs. 96.12±20.18, p=0.044, respectively).

CONCLUSION

Although foveal retinal thickness and nasal retinal nerve fiber layer thickness are affected in patients undergoing catheter ablation for ventricular arrhythmia, the stable retinal and optic disc vessel densities can be explained by the administration of effective anticoagulants during the procedure.

Best Practices for the Catheter Ablation of Ventricular Arrhythmias

Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia. We discuss steps to make ablation safe and prevent complications, and techniques to improve the efficacy of ablation, including optimal use of electroanatomical mapping algorithms, energy delivery, intracardiac echocardiography, and selective use of mechanical circulatory support.