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INtra-procedural ultraSound Imaging for DEtermination of atrial wall thickness and acute tissue changes after isolation of the pulmonary veins with radiofrequency, cryoballoon or laser balloon energy: the INSIDE PVs study

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Abstract

Preliminary data in human suggest that both Intracardiac echocardiography (ICE) and Intravascular ultrasound (IVUS) can be used for real-time information on the left atrial (LA) wall thickness and on the acute tissue changes produced by energy delivery. This pilot study was conducted to compare ICE and IVUS for real-time LA wall imaging and assessment of acute tissue changes produced by radiofrequency (RF), cryo and laser catheter ablation. Patients scheduled for RF, cryoballoon or laser balloon Pulmonary Vein Isolation (PVI) catheter ablation were enrolled. Each pulmonary vein (PV) was imaged before and immediately after ablation with either ICE or IVUS. The performance of ICE and IVUS for imaging were compared. Pre- and post-ablation measurements (lumen and vessel diameters, areas and sphericity indexes, wall thickness and muscular sleeve thickness) were taken at the level of each PV ostium. A total of 48 PVs in 12 patients were imaged before and after ablation. Both ICE and IVUS showed acute tissue changes. Compared to IVUS, ICE showed higher imaging quality and inter-observer reproducibility of the PV measurements obtained. Acute wall thickening suggestive of oedema was observed after RF treatment (p = 0.003) and laser treatment (p = 0.003) but not after cryoablation (p = 0.69). Our pilot study suggests that ICE might be preferable to IVUS for LA wall thickness imaging at the LA-PV junctions during ablation. Ablation causes acute wall thickening when using RF or laser energy, but not cryoenergy delivery. Larger studies are needed to confirm these preliminary findings.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AF:

Atrial fibrillation

ICE:

Intracardiac echocardiography

IQR:

Interquartile range

IVUS:

Intravascular ultrasound

LA:

Left atrial

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

PVs:

Pulmonary veins

RF:

Radiofrequency

SD:

Standard deviation

WTI:

Wall thickness index

WTI%:

Wall thickness index percentage

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Acknowledgements

We thank the John Radcliffe Hospital Cardiac Angiography Suite Team and the Oxford Cardiac Research Team for their invaluable help and support for the conduction of the study.

Funding

This study was funded by a grant of the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. Prof. Betts is supported by the Oxford NIHR Biomedical Research Centre. Dr Leo’s salary was supported by an unrestricted research grant from Abbott Medical.

Author information

Authors and Affiliations

  1. Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK

    Milena Leo, Giovanni Luigi De Maria, Andre Briosa e Gala, Michael Pope, Andrew Kelion, Michala Pedersen, Kim Rajappan, Matthew Ginks & Yaver Bashir

  2. Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK

    Abhirup Banerjee

  3. Barts Heart Centre, London, UK

    Ross J. Hunter

  4. Oxford NIHR Biomedical Research Centre, Oxford, UK

    Tim Betts

Authors
  1. Milena Leo
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  2. Giovanni Luigi De Maria
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  3. Andre Briosa e Gala
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  4. Michael Pope
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  5. Abhirup Banerjee
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  6. Andrew Kelion
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  7. Michala Pedersen
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  8. Kim Rajappan
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  9. Matthew Ginks
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  10. Yaver Bashir
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  11. Ross J. Hunter
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  12. Tim Betts
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ML and GLDM. The first draft of the manuscript was written by ML and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Milena Leo.

Ethics declarations

Conflict of interest

Dr Ginks has received speaker’s fees from Abbott and Biosense Webster. Dr Rajappan has received speaker’s fees from Abbott. Dr Hunter has received research grants, educational grants and speaker’s fees from Biosense Webster and Medtronic; he is an inventor of the STAR Mapping system and shareholder in Rhythm AI Ltd. Dr Betts has received research funding, speaker’s fees and advisory board fees from Abbott. The other authors have no conflict of interests to declare.

Ethical approval

The INSIDE PVs study was approved by the Health Research Authority West Midlands Coventry and Warwickshire Research Ethics committee and conducted in accordance with the Declaration of Helsinki (REC number 16/WM/0379).

Informed consent

All patients provided informed consent for participation in the INSIDE PVs study. All patients provided informed consent for anonymous publication of the results of the study.

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Leo, M., De Maria, G.L., Briosa e Gala, A. et al. INtra-procedural ultraSound Imaging for DEtermination of atrial wall thickness and acute tissue changes after isolation of the pulmonary veins with radiofrequency, cryoballoon or laser balloon energy: the INSIDE PVs study. Int J Cardiovasc Imaging 37, 3525–3535 (2021). https://doi.org/10.1007/s10554-021-02417-7

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  • DOI: https://doi.org/10.1007/s10554-021-02417-7

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