Real-time echo-figured left atrium imaging (ELAI) reduced right pulmonary vein ablation time by 20%, ablation seconds by 18%, and energy by 10%, with less additional re-isolation energy (p<0.05).
Does real-time left atrium imaging configured by intracardiac echocardiography (ELAI) improve procedural metrics in patients undergoing pulmonary vein isolation for atrial fibrillation?
The use of real-time left atrium imaging configured by intracardiac echocardiography (ELAI) improves procedural efficiency by reducing ablation time and energy delivery during right pulmonary vein isolation.
Absolute Event Rate: 0% vs 0%
Abstract Background Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF). Three-dimensional mapping system plays an important role to accomplish PVI effectively and safely. CT merge with catheter based fast anatomical mapping (FAM) or intracardiac echocardiography (ICE) became popular, however, anatomical information of CT is frequently different from real-time mapping data because left atrium (LA) anatomy is affected by afterload or respiratory condition. Currently, real-time full LA-image configured by contours with ICE is also available on CARTOSOUND ®module even though it requires to handle ultrasound catheter in LA to gain three plains. We studied whether echo-figured LA image (ELAI) with ultrasound catheter improved ablation procedure. Method A total of 148 patients (age;71.6±10.1, non-paroxysmal AF; N=60 (52.6%), female; N=36 (31.5%)) were studied retrospectively who underwent bi-extensive encircling (EE) PVI including posterior wall isolation by radiofrequency catheter ablation (RFCA) with CARTO ver3.7 and THERMOCOOL SMARTTOUCH SF as the first session in our institute from January 2023 to July 2024. We compared nominal CT-merge group and obtained ELAI group. Enhance or plain CT were obtained within a week before the session. CT-merge was done in all patients by FAM or ultrasound catheter obtained via RA. Additionally, in ELAI group (n=67, 58.7%), real-time left atrium image was configurated with contours obtained via both RA and LA. Especially in LA, PV anatomical contours were obtained (Figure 1). CT-merge image and ELAI were both referred during ablation procedure in ELAI group (Figure 2). Successful PV first-pass isolation was defined as one-round isolation. After initial isolation, 15 minutes-waiting was required. Isoproterenol and adenosine triphosphate infusion was used to detect dormant conduction. Result All patients received successful EEPVI including posterior wall isolation. RPVI-procedure time, ablation seconds, and delivered energy was reduced in ELAI-group (17.1±6.0 min vs. 13.7±4.7 min, p=0.001, 660±183 sec vs. 538 ± 135 sec, P0.001, 23861±6567 joule vs. 21531 ± 3230 joule, p=0.046, respectively), while parameters of LPV-ablation were not reduced. As for acute PV-reconnection, there was no difference between the groups, however, less additional application for re-isolation was required in ELAI groups (9181±4309 joule vs. 4242 ±2930 joule, p=0.035). Conclusion ELAI-technique might improve energy delivery in RFCA, especially in RPV-ablation.Figure 1 Figure 2
Ashida et al. (Sat,) reported a other. Real-time echo-figured left atrium imaging (ELAI) reduced right pulmonary vein ablation time by 20%, ablation seconds by 18%, and energy by 10%, with less additional re-isolation energy (p<0.05).