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Advantages of the integration of ICE and 3D electroanatomical mapping and ultrasound-guided femoral venipuncture in catheter ablation of atrial fibrillation

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Abstract

Purpose

To evaluate how the integration of intracardiac echocardiography (ICE) and ultrasound-guided femoral venipuncture (USGVC) may affect the safety of catheter ablation (CA) of atrial fibrillation (AF).

Methods

From a single center 374 patients with AF underwent 3D electroanatomic mapping–guided CA with or without the integration of ICE and USGVC. The primary endpoints were periprocedural complications, fluoroscopy time, and procedure time between the two groups.

Results

The median age of patients was 60 years. Sixteen patients had major complications (4.3%); 10 of these (2.7%) had major vascular complications. Thirty-seven patients had minor complications (9.9%) that did not require intervention. There were fewer major complications in the CA with the aid of ICE and USGVC than in the conventional approach (1% vs 7%, p = 0.004). The combined approach required less fluoroscopy time than the conventional procedure (median with ICE + USGVC 14 min (interquartile range (IQR) 8–21) vs median without ICE + USGVC 22 min (IQR 17–32)), p < 0.001, and less radiofrequency time (median with ICE + USGVC 1686 s (IQR 1367–1998) vs median time without ICE + USGVC: 1792 s (IQR 1390–2400)), p = 0.012. After adjustment for confounding factors, only the use of ICE + USGVC (hazard ratio: 0.139; p = 0.05) was a significantly protective factor against major complications.

Conclusion

The use of ICE and USGVC in CA of AF is associated with significantly fewer major complications and lower fluoroscopy and radiofrequency time, so these aids increased the safety of the procedure.

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Authors and Affiliations

  1. Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy

    Carmelo La Greca, Alberico Sorgato, Umberto Simoncelli & Domenico Pecora

  2. Functional Cardiology Unit, Casa di Cura “Villa Azzurra”, Siracusa, Italy

    Arianna Cirasa

  3. Cardiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy

    Davide Di Modica

Authors
  1. Carmelo La Greca
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  2. Arianna Cirasa
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  3. Davide Di Modica
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  4. Alberico Sorgato
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  5. Umberto Simoncelli
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  6. Domenico Pecora
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Corresponding author

Correspondence to Arianna Cirasa.

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The authors declare that they have no conflict of interest.

Ethical approval

The institutional review board approval was given under the condition that the patients’ data were collected in an aggregate and anonymized form.

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Informed consent was obtained from all individual participants included in the study.

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CONDENSED ABSTRACT

From a single center 374 patients with atrial fibrillation (AF) underwent radiofrequency catheter ablation (CA) with or without the integration of intracardiac echocardiography (ICE) and ultrasound-guided femoral venipuncture cannulation (USGVC). There were fewer major complications in the CA with the aid of ICE and USGVC than in the conventional approach (1% vs 7%, p = 0.004). The combined approach required less fluoroscopy (median with ICE + USGVC: 14 minutes vs median without ICE + USGVC: 22 minutes, p < 0.001), and radiofrequency (median with ICE + USGVC 1686 seconds vs median time without ICE + USGVC 1792 seconds, p = 0.012) time than the conventional procedure. The use of ICE and USGVC in CA of AF increased the safety of the procedure.

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La Greca, C., Cirasa, A., Di Modica, D. et al. Advantages of the integration of ICE and 3D electroanatomical mapping and ultrasound-guided femoral venipuncture in catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 61, 559–566 (2021). https://doi.org/10.1007/s10840-020-00835-6

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  • DOI: https://doi.org/10.1007/s10840-020-00835-6

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