Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK.
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Int J Cardiovasc Imaging. 2021 Dec;37(12):3525-3535. doi: 10.1007/s10554-021-02417-7. Epub 2021 Sep 23.
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.
初步的人体数据表明，心腔内超声（ICE）和血管内超声（IVUS）均可用于实时获取左心房（LA）壁厚度信息以及能量传递引起的急性组织变化。这项初步研究旨在比较 ICE 和 IVUS 在心腔内实时 LA 壁成像以及评估射频（RF）、冷冻球囊和激光导管消融引起的急性组织变化方面的应用。纳入计划接受 RF、冷冻球囊或激光球囊肺静脉隔离（PVI）导管消融的患者。每个肺静脉（PV）在消融前和消融后均用 ICE 或 IVUS 进行成像。比较 ICE 和 IVUS 的成像性能。在每个 PV 口水平进行消融前后的测量（管腔和血管直径、面积和球度指数、壁厚度和肌袖厚度）。共对 12 例患者的 48 个 PV 进行了消融前后的成像。ICE 和 IVUS 均显示出急性组织变化。与 IVUS 相比，ICE 显示出更高的成像质量和 PV 测量的观察者间可重复性。在 RF 治疗（p = 0.003）和激光治疗（p = 0.003）后观察到提示水肿的急性壁增厚（p = 0.003），但在冷冻消融后未见（p = 0.69）。我们的初步研究表明，在消融过程中，ICE 可能优于 IVUS 用于 LA-PV 交界处的 LA 壁厚度成像。当使用 RF 或激光能量时，消融会导致急性壁增厚，但冷冻能量输送不会。需要更大的研究来证实这些初步发现。
