Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Pacing Clin Electrophysiol. 2021 Sep;44(9):1487-1496. doi: 10.1111/pace.14315. Epub 2021 Jul 16.
Intracardiac echocardiography (ICE) has become an all-round tool for ablation of atrial fibrillation (AF) since it plays an important role in all procedural steps. The key upgrade to the usefulness of ICE is its integration into three-dimensional (3D) electroanatomic mapping (EAM) system (ICE/EAM automatic integration system). The aim of this single-center retrospective study was to evaluate feasibility, safety and acute efficacy of ICE/EAM automatic integration system guided fluoroless ablation of AF.
The study included patients with symptomatic paroxysmal or persistent AF undergoing first pulmonary vein isolation (PVI) radiofrequency (RF) catheter ablation (RFCA) from September 2017 to August 2020. All procedures were performed without the use of fluoroscopy. A detailed 3D virtual anatomy of the left atrium (LA) and structures relevant to AF ablation was constructed from ultrasound contours obtained with ICE probe inside the LA. Pulmonary veins (PVs) and antral regions were additionally mapped with fast anatomical mapping (FAM). PVI was performed with contact force (CF) sensing catheter. Procedural endpoint was successful PVI.
A total of 98 consecutive patients underwent RFCA (34.7% females, median age 64.4 years, 64.3% paroxysmal AF). Acute PVI was achieved in all patients (100%). Forty-three patients (43.9%) underwent additional ablations for concomitant arrhythmias. Adverse events were detected in four patients (4.1%). The median procedure duration was 130 min (IQR 103.8-151.3). If only PVI was done the median procedure duration was 110.5 (IQR 100.0-133.8) CONCLUSIONS: ICE/EAM automatic integration system guided fluoroless ablation of AF is feasible, safe and acutely effective method for treatment of symptomatic AF.
心脏内超声心动图（ICE）在房颤（AF）消融中已成为一种全能工具，因为它在所有程序步骤中都发挥着重要作用。ICE 的一个关键升级是将其集成到三维（3D）电解剖图（EAM）系统中（ICE/EAM 自动集成系统）。这项单中心回顾性研究旨在评估 ICE/EAM 自动集成系统引导下无氟消融治疗 AF 的可行性、安全性和急性疗效。
该研究纳入了 2017 年 9 月至 2020 年 8 月期间因有症状的阵发性或持续性 AF 而行首次肺静脉隔离（PVI）射频（RF）导管消融（RFCA）的患者。所有手术均在不使用透视的情况下进行。通过在左心房（LA）内部使用 ICE 探头获取的超声轮廓构建 LA 和与 AF 消融相关的结构的详细 3D 虚拟解剖结构。PV 和窦房区也可以通过快速解剖图（FAM）进行额外的映射。PVI 采用接触力（CF）感测导管进行。程序终点为成功的 PVI。
共 98 例连续患者接受了 RFCA（女性占 34.7%，中位年龄 64.4 岁，64.3%为阵发性 AF）。所有患者均实现了急性 PVI（100%）。43 例（43.9%）患者因同时发生心律失常而进行了额外消融。4 例（4.1%）患者检测到不良事件。中位手术时间为 130 分钟（IQR 103.8-151.3）。如果仅行 PVI，则中位手术时间为 110.5 分钟（IQR 100.0-133.8）。
ICE/EAM 自动集成系统引导下无氟消融治疗 AF 是一种可行、安全和有效的治疗有症状 AF 的方法。
