Role of intracardiac echocardiography in catheter ablation of heart rhythm disturbances

Czech version

Authors: T. Skála; M. Táborský
Authors‘ workplace: I. interní klinika – kardiologická LF UP a FN Olomouc
Published in: Kardiol Rev Int Med 2017, 19(4): 237-242

Overview

Catheter ablation is an established method of heart rhythm disturbances treatment. With an increasing number of ablations, it is imperative to further minimise the risks and maximise efficacy of this treatment. Intracardiac echocardiography is a cardiac imaging method made possible thanks to a steerable catheter inserted from the groin into the heart. ICE allows us to precisely visualise all cardiac structures and all material inserted in the heart, including diagnostic and ablation catheters. ICE improves safety and efficacy of ablation by monitoring of catheter position, ablation lesion formation, proximity to oesophagus, and presence of thrombi, needle position before transseptal puncture and generally by allowing a precise definition of an optimal place for ablation in atria and ventricles. Thanks to ICE, an operator sees what he or she is doing in real time. This makes ICE one of the most important tools in clinical electrophysiology.

Key words:
intracardiac echocardiography – catheter ablation – safety – efficacy

Sources

1. Bulava A a kol. Intrakardiální echokardiografie v elektrofyziologii. Praha: Grada Publishing 2016.

2. Marrouche NF, Martin DO, Wazni O et al. Phased-array intracardiac echocardiography monitoring during pulmonary vein isolation in patients with atrial fibrillation. Circulation 2003; 107(21): 2710– 2716. doi: 10.1161/ 01.CIR.0000070541.83326.15.

3. Packer DL, Stevens CL, Curley MG et al. Intracardiac phased-array imaging: methods and initial clinical experience with high resolution, under blood visualization. J Am Coll Cardiol 2002; 39(3): 509– 516. doi: 10.1016/ S0735-1097(01)01764-8.

4. Nairooz R, Sardar P, Pino M et al. Meta-analysis of risk of stroke and thrombo-embolism with rivaroxaban versus vitamin K antagonists in ablation and cardioversion of atrial fibrillation. Int J Cardiol 2015; 187: 345– 353. doi: 10.1016/ j.ijcard.2015.03.323.

5. Santangeli P, Di Biase L, Burkhardt JD et al. Transseptal access and atrial fibrillation ablation guided by intracardiac echocardiography in patients with atrial septal closure devices. Heart Rhythm 2011; 8(11): 1669– 1675. doi: 10.1016/ j.hrthm.2011.06.023.

6. Reddy VY, Shah D, Kautzner J et al. The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm 2012; 9(11): 1789– 1795. doi: 10.1016/ j.hrthm.2012.07.016.

7. Anter E, Silverstein J, Tschabrunn CM et al. Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages. Heart Rhythm 2014; 11(11): 1890– 1897. doi: 10.1016/ j.hrthm.2014.07.015.

8. Kautzner J, Peichl P. The role of imaging to support catheter ablation of atrial fibrillation. CorVasa 2012; 54(6): e375– e385. doi: 10.1016/ j.crvasa.2012.11.009.

9. Ghi KK, Chugh A, Good E et al. A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. J Interv Card Electrophysiol 2009; 24(1): 33– 36. doi: 10.1007/ s10840-008-9307-1.

10. Morton JB, Sanders P, Davidson NC et al. Phased-array intracardiac echocardiography for defining cavotricuspid isthmus anatomy during radiofrequency ablation of typical atrial flutter. J Cardiovasc Electrophysiol 2003; 14(6): 591– 597. doi: 10.1046/ j.1540-8167.2003.02152.x.

11. Jongbloed MR, Bax JJ, van der Burg AE et al. Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography. Eur J Echocardiogr 2004; 5(1): 34– 40. doi: 10.1016/ S1525-2167(03)00051-9.

12. Kanagaratnam L, Tomassoni G, Schweikert Ret al. Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia. J Am Coll Cardiol 2001; 37(5): 1408– 1414. doi: 10.1016/ S0735-1097(01)01127-5.

13. Peichl P, Baran J, Wichterle D et al. The tip of the muscle is a dominant location of ventricular ectopy originating from papillary muscles in the left ventricle. J Cardiovasc Electrophysiol 2017. [Epub ahead of print] doi: 10.1111/ jce.13338.