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Intracardiac echocardiography–guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience

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Abstract

Background

Intracardiac echocardiography (ICE) is increasingly employed in atrial fibrillation (AF) ablation procedures, with the potential to enhance procedural efficacy. Nevertheless, there is currently a lack of evidence assessing the impact of ICE on the efficiency, effectiveness, and safety outcomes in the context of novel pulsed-field ablation (PFA) for AF.

Purpose

We aimed to assess whether the use of ICE could improve procedural parameters in a large population undergoing AF ablation with FARAPULSE™ catheter.

Methods

Consecutive patients who had undergone PFA of AF from nine Italian centers were included. In procedures where the ICE catheter was employed for guidance (ICE-guided group), it was used to maneuver the PFA catheter within the left atrium to achieve optimal contact with atrial structures.

Results

We analyzed 556 patients: 357 (66%) with paroxysmal AF, 499 (89.7%) de novo PVI. ICE-guided procedures (n = 138) were propensity matched with patients with a standard approach (n = 138), and their outcomes were compared. During ICE-guided procedures, no improvement in procedural metrics was recorded (ICE vs Standard, 23 ± 6 min vs 18.5 ± 9 min for time to PVI, p < 0.0001; 38.8 ± 7 vs 32.5 ± 5 number of PFA deliveries to achieve PVI, p < 0.0001; 68.8 ± 19 min vs 71.8 ± 29 min for primary operator time, p = 0.5301; 16.1 ± 8 min vs 18.2 ± 10 min for fluoroscopy time, p = 0.5476) except for support time (76.8 ± 26 min vs 91.4 ± 37 min, p = 0.0046). No major procedure-related adverse events were reported.

Conclusion

Our findings confirmed that PFA could be consistently performed in a rapid, safe, and efficacious manner. The use of ICE to guide PFA was not associated with an improvement in procedural metrics.

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Authors and Affiliations

  1. Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Via Conca, 71 - 60126, Ancona, Italy

    Antonio Dello Russo, Michela Casella, Paolo Compagnucci, Laura Cipolletta & Quintino Parisi

  2. Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy

    Antonio Dello Russo, Paolo Compagnucci & Francesco Solimene

  3. Centro Cardiologico Monzino, IRCCS, Milan, Italy

    Claudio Tondo, Gaetano Fassini & Marco Schiavone

  4. Montevergine Clinic, Mercogliano, AV, Italy

    Vincenzo Schillaci, Armando Salito & Francesco Solimene

  5. Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy

    Michela Casella

  6. Maria Cecilia Hospital, Cotignola, RA, Italy

    Saverio Iacopino & Pasquale Filannino

  7. Fatebenefratelli Isola Tiberina - Gemelli Isola Hospital, Rome, Italy

    Stefano Bianchi & Pietro Rossi

  8. San Bortolo Hospital, Vicenza, Italy

    Antonio Rossillo & Carlo Bonanno

  9. Degli Infermi Hospital, Rivoli, TO, Italy

    Ruggero Maggio

  10. Dell’Angelo Hospital, Mestre, VE, Italy

    Sakis Themistoclakis

  11. San Filippo Neri Hospital, Rome, Italy

    Claudio Pandozi

  12. Boston Scientific, Milan, Italy

    Maurizio Malacrida

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  1. Antonio Dello Russo
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Correspondence to Antonio Dello Russo.

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M.M is an employee of Boston Scientific. The other authors have no conflicts of interest to declare.

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Dello Russo, A., Tondo, C., Schillaci, V. et al. Intracardiac echocardiography–guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience. J Interv Card Electrophysiol (2023). https://doi.org/10.1007/s10840-023-01699-2

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