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Torma D, Janosi K, Debreceni D, Bocz B, Keseru M, Simor T, Kupo P. Initial experience with zero-fluoroscopy pulmonary vein isolation in patients with atrial fibrillation: single-center observational trial. Sci Rep 2024; 14:16332. [PMID: 39009806 PMCID: PMC11251150 DOI: 10.1038/s41598-024-67183-7] [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: 02/14/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
Pulmonary vein isolation (PVI) stands as a widely practiced cardiac ablation procedure on a global scale, conventionally guided by fluoroscopy. The concurrent application of electroanatomical mapping systems (EAMS) and intracardiac echocardiography offers a means to curtail radiation exposure. This study aimed to compare procedural outcomes between conventional and our initial zero-fluoroscopy cases in patients with paroxysmal or persistent atrial fibrillation (AF), undergoing point-by-point PVI. Our prospective observational study included 100 consecutive patients with AF who underwent point-by-point radiofrequency PVI. The standard technique was used in the first 50 cases (Standard group), while the fluoroless technique was used in the subsequent 50 patients (Zero group). The zero-fluoroscopy approach exhibited significantly shorter procedural time (59.6 ± 10.7 min vs. 74.6 ± 13.2 min, p < 0.0001), attributed to a reduced access time (17 [16; 20] min vs. 31 [23; 34.5] min, p < 0.001). Comparable results were found for the number of RF applications, total ablation energy, and left atrial dwelling time. In the Zero group, all procedures were achieved without fluoroscopy, resulting in significantly lower fluoroscopy time (0 [0; 0] sec vs. 132 [100; 160] sec, p < 0.0001) and dose (0 [0; 0] mGy vs. 4.8 [4.1; 8.2] mGy, p < 0.0001). The acute success rate was 100%, with no major complications. Zero-fluoroscopy PVI is feasible, safe, and associated with shorter procedure times compared to the standard approach, even in cases without prior experience in zero-fluoroscopy PVI.
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Affiliation(s)
- Dalma Torma
- Medical School, Heart Institute, University of Pecs, Ifjusag utja 13., 7624, Pecs, Hungary
| | - Kristof Janosi
- Medical School, Heart Institute, University of Pecs, Ifjusag utja 13., 7624, Pecs, Hungary
| | - Dorottya Debreceni
- Medical School, Heart Institute, University of Pecs, Ifjusag utja 13., 7624, Pecs, Hungary
| | - Botond Bocz
- Medical School, Heart Institute, University of Pecs, Ifjusag utja 13., 7624, Pecs, Hungary
| | - Mark Keseru
- Medical School, Heart Institute, University of Pecs, Ifjusag utja 13., 7624, Pecs, Hungary
| | - Tamas Simor
- Medical School, Heart Institute, University of Pecs, Ifjusag utja 13., 7624, Pecs, Hungary
| | - Peter Kupo
- Medical School, Heart Institute, University of Pecs, Ifjusag utja 13., 7624, Pecs, Hungary.
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Sousonis V, Asvestas D, Vavouris E, Karanikas S, Ypsilanti E, Tzeis S. The use of Intracardiac Echocardiography in Catheter Ablation of Atrial Fibrillation. Curr Cardiol Rep 2024:10.1007/s11886-024-02091-w. [PMID: 38995505 DOI: 10.1007/s11886-024-02091-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE OF THE REVIEW Intracardiac echocardiography (ICE) provides real-time, fluoroless imaging of cardiac structures, allowing optimal catheter positioning and energy delivery during ablation procedures. This review summarizes the use of ICE in catheter ablation of atrial fibrillation (AF). RECENT FINDINGS Growing evidence suggests that the use of ICE improves procedural safety and facilitates radiofrequency and cryoballoon AF ablation. ICE-guided catheter ablation is associated with reduced procedural duration and fluoroscopy use. Recent studies have examined the role of ICE in guiding novel ablation techniques, such as pulsed field ablation. Finally, the use of ICE allows for early detection and timely management of potentially serious procedural complications. Intracardiac echocardiography offers significant advantages during AF ablation procedures and its use should be encouraged to improve procedural safety and efficacy.
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Affiliation(s)
- Vasileios Sousonis
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Dimitrios Asvestas
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Emmanouil Vavouris
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Stavros Karanikas
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Elissavet Ypsilanti
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece
| | - Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6 Erithrou Stavrou str., Marousi, Athens, 151 23, Greece.
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Di Biase L, Zou F, Lin AN, Grupposo V, Marazzato J, Tarantino N, Della Rocca D, Mohanty S, Natale A, Alhuarrat MAD, Haiman G, Haimovich D, Matthew RA, Alcazar J, Costa G, Urman R, Zhang X. Feasibility of three-dimensional artificial intelligence algorithm integration with intracardiac echocardiography for left atrial imaging during atrial fibrillation catheter ablation. Europace 2023; 25:euad211. [PMID: 37477946 PMCID: PMC10403247 DOI: 10.1093/europace/euad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
AIMS Intracardiac echocardiography (ICE) is a useful but operator-dependent tool for left atrial (LA) anatomical rendering during atrial fibrillation (AF) ablation. The CARTOSOUND FAM Module, a new deep learning (DL) imaging algorithm, has the potential to overcome this limitation. This study aims to evaluate feasibility of the algorithm compared to cardiac computed tomography (CT) in patients undergoing AF ablation. METHODS AND RESULTS In 28 patients undergoing AF ablation, baseline patient information was recorded, and three-dimensional (3D) shells of LA body and anatomical structures [LA appendage/left superior pulmonary vein/left inferior pulmonary vein/right superior pulmonary vein/right inferior pulmonary vein (RIPV)] were reconstructed using the DL algorithm. The selected ultrasound frames were gated to end-expiration and max LA volume. Ostial diameters of these structures and carina-to-carina distance between left and right pulmonary veins were measured and compared with CT measurements. Anatomical accuracy of the DL algorithm was evaluated by three independent electrophysiologists using a three-anchor scale for LA anatomical structures and a five-anchor scale for LA body. Ablation-related characteristics were summarized. The algorithm generated 3D reconstruction of LA anatomies, and two-dimensional contours overlaid on ultrasound input frames. Average calculation time for LA reconstruction was 65 s. Mean ostial diameters and carina-to-carina distance were all comparable to CT without statistical significance. Ostial diameters and carina-to-carina distance also showed moderate to high correlation (r = 0.52-0.75) except for RIPV (r = 0.20). Qualitative ratings showed good agreement without between-rater differences. Average procedure time was 143.7 ± 43.7 min, with average radiofrequency time 31.6 ± 10.2 min. All patients achieved ablation success, and no immediate complications were observed. CONCLUSION DL algorithm integration with ICE demonstrated considerable accuracy compared to CT and qualitative physician assessment. The feasibility of ICE with this algorithm can potentially further streamline AF ablation workflow.
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Affiliation(s)
- Luigi Di Biase
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | - Fengwei Zou
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | - Aung N Lin
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | | | - Jacopo Marazzato
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Tarantino
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | | | - Sanghamitra Mohanty
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Majd Al Deen Alhuarrat
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
| | | | | | | | | | | | - Roy Urman
- Biosense Webster, Inc., Irvine, CA, USA
| | - Xiaodong Zhang
- Montefiore-Einstein Center for Heart & Vascular Care, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY, USA
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Velagic V, Mugnai G, Prepolec I, Pasara V, Puljevic M, Pezo-Nikolic B, Puljević D, de Asmundis C, Chierchia GB, Milicic D. Radiation dose reduction in the setting of cryoballoon ablation for atrial fibrillation: the value of optimized fluoroscopy settings and intracardiac echocardiography. Int J Cardiovasc Imaging 2023; 39:245-254. [PMID: 36598699 DOI: 10.1007/s10554-022-02717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/10/2022] [Indexed: 01/11/2023]
Abstract
Cryoballoon (CB) has proven to be very effective in the percutaneous treatment of atrial fibrillation (AF). CB ablation is still hampered by X-ray exposure and the doses applied are consistently higher if compared to radiofrequency ablation. All patients who underwent CB ablation between 2015 and 2020 were analysed. Intracardiac echography was consistently used for transeptal puncture. To demonstrate the differences in radiation exposure 3 groups of 50 consecutive patients were selected. In the first group (G1) 3D rotational angiography (3DRA) was used as an intraprocedural imaging method. In the second group (G2), traditional X-ray imaging was used and frame rates both for fluoro and cine modes of diascopy were lowered. In the third group (G3) only 2-3 frames per second were used, cine mode was abandoned and the grid was removed from the X-ray detector. A total of 150 patients were included (76% males, mean age 57.3 ± 11.5 years). A dramatic reduction of radiation dose was obtained from 9585 ± 5610 µGy/m2 in G1 to 2469 ± 2002 µGy/m2 in G2 and finally 227.1 ± 360 µGy/m2 in G3 (p < 0.0001). There was also a significant decrease of procedural and fluoroscopy times. No difference in major complications and midterm outcomes was found between the groups. By following a few relatively simple steps (omitting the pre-procedural imaging, removing grid from the X-ray detector and using very low frame rates) CB ablation could be performed with ultralow radiation exposure without compromising the safety of efficacy of the procedure.
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Affiliation(s)
- Vedran Velagic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Giacomo Mugnai
- Electrophysiology and Cardiac Pacing, Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Ivan Prepolec
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Vedran Pasara
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Mislav Puljevic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Borka Pezo-Nikolic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Puljević
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | | | | | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
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Guo R, Jia R, Cen Z, Lu S, Yang C, Han S, Li D, Cui K. Effects of the visualized steerable sheath applied to catheter ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2021; 64:511-518. [PMID: 34850310 DOI: 10.1007/s10840-021-01096-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/17/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE A new type of visualized steerable sheath (Vizigo sheath; Biosense Webster Inc., Irvine, CA, USA) has been employed in clinical treatment. This study aimed to compare the effectiveness and safety of the Vizigo sheath to a fixed sheath (Swartz sheath; St. Jude Inc., St. Paul, MN, USA) for catheter ablation of paroxysmal atrial fibrillation (PAF). METHODS We analyzed the procedural time, fluoroscopy time, contact force (CF), and initial pulmonary vein isolation (PVI) rate. After 6 months of follow-up, the success rate of ablation between the two groups was compared. RESULTS Compared to the Swartz sheath, using the Vizigo sheath can significantly reduce the total procedural time and fluoroscopy time and increase the overall average CF, especially in the anterior left pulmonary vein (LPV), superior LPV, posterior right pulmonary vein (RPV), and superior RPV. The proportion of CF within a reasonable range in the Vizigo group was significantly higher than that in the Swartz group, especially in the anterior LPV, posterior RPV, and superior RPV. Besides, the left, right, and bilateral initial PVI rates in the Vizigo group were significantly higher. CONCLUSIONS The visualized steerable sheath for PAF catheter ablation not only reduced radiation exposure but also significantly improved CF and initial PVI rate, all of which indicated an increased rate of successful ablation.
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Affiliation(s)
- Ran Guo
- West China Hospital, (Department of Cardiology), Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ruikun Jia
- West China Hospital, (Department of Cardiology), Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhifu Cen
- West China Hospital, (Department of Cardiology), Sichuan University, Chengdu, 610041, People's Republic of China
| | - Sijie Lu
- West China Hospital, (Department of Cardiology), Sichuan University, Chengdu, 610041, People's Republic of China
| | - Chao Yang
- West China Hospital, (Department of Cardiology), Sichuan University, Chengdu, 610041, People's Republic of China
| | - Shaojie Han
- West China Hospital, (Department of Cardiology), Sichuan University, Chengdu, 610041, People's Republic of China
| | - Dong Li
- Mianyang Central Hospital, (Department of Cardiology), University of Electronic Science and Technology of China, Mianyang, 621000, People's Republic of China.
| | - Kaijun Cui
- West China Hospital, (Department of Cardiology), Sichuan University, Chengdu, 610041, People's Republic of China.
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