Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter
Abstract Introduction One of the most helpful aspects of intracardiac echocardiography (ICE) implementation in electrophysiological studies (EPS) is the real-time visualisation of catheters and cardiac structures. In this prospective study, we investigated ICE-guided zero-fluoroscopy catheter naviga...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Cardiovascular Ultrasound |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12947-023-00312-w |
| _version_ | 1797453749628698624 |
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| author | Blerim Luani Maksim Basho Ammar Ismail Thomas Rauwolf Sven Kaese Ndricim Tobli Alexander Samol Katharina Pankraz Alexander Schmeisser Marcus Wiemer Rüdiger C. Braun-Dullaeus Conrad Genz |
| author_facet | Blerim Luani Maksim Basho Ammar Ismail Thomas Rauwolf Sven Kaese Ndricim Tobli Alexander Samol Katharina Pankraz Alexander Schmeisser Marcus Wiemer Rüdiger C. Braun-Dullaeus Conrad Genz |
| author_sort | Blerim Luani |
| collection | DOAJ |
| description | Abstract Introduction One of the most helpful aspects of intracardiac echocardiography (ICE) implementation in electrophysiological studies (EPS) is the real-time visualisation of catheters and cardiac structures. In this prospective study, we investigated ICE-guided zero-fluoroscopy catheter navigation during radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) in patients with typical atrial flutter (AFL). Methods and results Thirty consecutive patients (mean age 72.9 ± 11.4 years, 23 male) with ongoing (n = 23) or recent CTI-dependent AFL underwent an EPS, solely utilizing ICE for catheter navigation. Zero-fluoroscopy EPS could be successfully accomplished in all patients. Mean EPS duration was 41.4 ± 19.9 min, and mean ablation procedure duration was 20.8 ± 17.1 min. RF ablation was applied for 6.0 ± 3.1 min (50W, irrigated RF ablation). Echocardiographic parameters, such as CTI length, prominence of the Eustachian ridge (ER), and depth of the CTI pouch on the ablation plane, were assessed to analyse their correlation with EPS- or ablation procedure duration. The CTI pouch was shallower in patients with an ablation procedure duration above the median (4.8 ± 1.1 mm vs. 6.4 ± 0.9 mm, p = 0.04), suggesting a more lateral ablation plane in these patients, where the CTI musculature is stronger. CTI length or ER prominence above the respective median did not correlate with longer EPS duration. Conclusions Zero-fluoroscopy CTI ablation guided solely by intracardiac echocardiography in patients with CTI-dependent AFL is feasible and safe. ICE visualisation may help to localise the optimal ablation plane, detect and correct poor tissue contact of the catheter tip, and recognise early potential complications during the ablation procedure. Graphical Abstract |
| first_indexed | 2024-03-09T15:27:22Z |
| format | Article |
| id | doaj.art-8a062cdbb3344cc88f88ace8aa03c8df |
| institution | Directory Open Access Journal |
| issn | 1476-7120 |
| language | English |
| last_indexed | 2024-03-09T15:27:22Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Ultrasound |
| spelling | doaj.art-8a062cdbb3344cc88f88ace8aa03c8df2023-11-26T12:28:28ZengBMCCardiovascular Ultrasound1476-71202023-08-012111910.1186/s12947-023-00312-wCatheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutterBlerim Luani0Maksim Basho1Ammar Ismail2Thomas Rauwolf3Sven Kaese4Ndricim Tobli5Alexander Samol6Katharina Pankraz7Alexander Schmeisser8Marcus Wiemer9Rüdiger C. Braun-Dullaeus10Conrad Genz11Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University BochumDepartment of Radiology, University Hospital Center Mother TeresaDepartment of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University BochumDepartment of Internal Medicine, Division of Cardiology and Angiology, Magdeburg UniversityDepartment of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University BochumDepartment of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University BochumDepartment of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University BochumDepartment of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University BochumDepartment of Internal Medicine, Division of Cardiology and Angiology, Magdeburg UniversityDepartment of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University BochumDepartment of Internal Medicine, Division of Cardiology and Angiology, Magdeburg UniversityDepartment of Internal Medicine, Division of Cardiology and Angiology, Magdeburg UniversityAbstract Introduction One of the most helpful aspects of intracardiac echocardiography (ICE) implementation in electrophysiological studies (EPS) is the real-time visualisation of catheters and cardiac structures. In this prospective study, we investigated ICE-guided zero-fluoroscopy catheter navigation during radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) in patients with typical atrial flutter (AFL). Methods and results Thirty consecutive patients (mean age 72.9 ± 11.4 years, 23 male) with ongoing (n = 23) or recent CTI-dependent AFL underwent an EPS, solely utilizing ICE for catheter navigation. Zero-fluoroscopy EPS could be successfully accomplished in all patients. Mean EPS duration was 41.4 ± 19.9 min, and mean ablation procedure duration was 20.8 ± 17.1 min. RF ablation was applied for 6.0 ± 3.1 min (50W, irrigated RF ablation). Echocardiographic parameters, such as CTI length, prominence of the Eustachian ridge (ER), and depth of the CTI pouch on the ablation plane, were assessed to analyse their correlation with EPS- or ablation procedure duration. The CTI pouch was shallower in patients with an ablation procedure duration above the median (4.8 ± 1.1 mm vs. 6.4 ± 0.9 mm, p = 0.04), suggesting a more lateral ablation plane in these patients, where the CTI musculature is stronger. CTI length or ER prominence above the respective median did not correlate with longer EPS duration. Conclusions Zero-fluoroscopy CTI ablation guided solely by intracardiac echocardiography in patients with CTI-dependent AFL is feasible and safe. ICE visualisation may help to localise the optimal ablation plane, detect and correct poor tissue contact of the catheter tip, and recognise early potential complications during the ablation procedure. Graphical Abstracthttps://doi.org/10.1186/s12947-023-00312-wCatheter ablationCavotricuspid isthmusZero-fluoroscopyIntracardiac echocardiography |
| spellingShingle | Blerim Luani Maksim Basho Ammar Ismail Thomas Rauwolf Sven Kaese Ndricim Tobli Alexander Samol Katharina Pankraz Alexander Schmeisser Marcus Wiemer Rüdiger C. Braun-Dullaeus Conrad Genz Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter Cardiovascular Ultrasound Catheter ablation Cavotricuspid isthmus Zero-fluoroscopy Intracardiac echocardiography |
| title | Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter |
| title_full | Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter |
| title_fullStr | Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter |
| title_full_unstemmed | Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter |
| title_short | Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter |
| title_sort | catheter navigation by intracardiac echocardiography enables zero fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter |
| topic | Catheter ablation Cavotricuspid isthmus Zero-fluoroscopy Intracardiac echocardiography |
| url | https://doi.org/10.1186/s12947-023-00312-w |
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