A saline contrast-enhanced echocardiography-guided approach to cryoballoon ablation.
atrial fibrillation
contrast medium
cryoballoon ablation
intracardiac echocardiography
radiation exposure
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
01
04
2020
revised:
01
05
2020
accepted:
10
05
2020
pubmed:
19
5
2020
medline:
6
10
2021
entrez:
19
5
2020
Statut:
ppublish
Résumé
Pulmonary vein isolation (PVI) with a cryoballoon usually uses iodinated contrast medium for confirmation of venous occlusion. We hypothesized that an alternative to angiography with iodinated contrast, saline bolus-enhanced echocardiography with the microbubbles formed in situ, could be used to assess venous occlusion. We sought to assess the efficacy and safety of the contrast-enhanced intracardiac echocardiographic (ICE) approach. Thirty-four consecutive patients without iodine sensitivity or renal insufficiency were studied to assess the accuracy of ICE-guided PV occlusion underwent both angiographic guidance and ICE guidance (validation group). Twenty consecutive patients with paroxysmal atrial fibrillation (AF) and contraindications to iodinated contrast medium (ICE-guided group) underwent PV occlusion and ablation with ICE guidance alone. Procedural results and clinical outcomes were compared with those of 245 control patients undergoing PVI by the conventional angiographic method (control group). In the validation group, ICE-guided PV occlusion was as effective as angiography-guided PV occlusion. In the ICE-guided group, two patients required touch-up ablation using a radiofrequency ablation catheter with fluoroscopic guidance. Procedure time, radiation exposure, and requirements for touch-up ablation were similar between the ICE-guided group and the control group. In patients requiring only PVI, the ICE-guided approach involved significantly less radiation exposure than the conventional approach. There was no significant difference in atrial fibrillation (AF)-free survival rate between the two groups during a follow-up period of 14 ± 6 months. An echo-guided approach using saline infusion was effective in terms of avoidance of iodinated contrast use and radiation exposure.
Sections du résumé
BACKGROUND
Pulmonary vein isolation (PVI) with a cryoballoon usually uses iodinated contrast medium for confirmation of venous occlusion. We hypothesized that an alternative to angiography with iodinated contrast, saline bolus-enhanced echocardiography with the microbubbles formed in situ, could be used to assess venous occlusion. We sought to assess the efficacy and safety of the contrast-enhanced intracardiac echocardiographic (ICE) approach.
METHODS
Thirty-four consecutive patients without iodine sensitivity or renal insufficiency were studied to assess the accuracy of ICE-guided PV occlusion underwent both angiographic guidance and ICE guidance (validation group). Twenty consecutive patients with paroxysmal atrial fibrillation (AF) and contraindications to iodinated contrast medium (ICE-guided group) underwent PV occlusion and ablation with ICE guidance alone. Procedural results and clinical outcomes were compared with those of 245 control patients undergoing PVI by the conventional angiographic method (control group).
RESULTS
In the validation group, ICE-guided PV occlusion was as effective as angiography-guided PV occlusion. In the ICE-guided group, two patients required touch-up ablation using a radiofrequency ablation catheter with fluoroscopic guidance. Procedure time, radiation exposure, and requirements for touch-up ablation were similar between the ICE-guided group and the control group. In patients requiring only PVI, the ICE-guided approach involved significantly less radiation exposure than the conventional approach. There was no significant difference in atrial fibrillation (AF)-free survival rate between the two groups during a follow-up period of 14 ± 6 months.
CONCLUSIONS
An echo-guided approach using saline infusion was effective in terms of avoidance of iodinated contrast use and radiation exposure.
Substances chimiques
Contrast Media
0
Sodium Chloride
451W47IQ8X
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
664-670Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Kuck KH, Brugada J, Furnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374:2235-2245.
Abdin A, Yalin K, Lyan E, et al. Safety and efficacy of cryoballoon ablation for the treatment of atrial fibrillation in elderly patients. Clin Res Cardiol. 2019;108:167-174.
Abugattas JP, Iacopino S, Moran D, et al. Efficacy and safety of the second generation cryoballoon ablation for the treatment of paroxysmal atrial fibrillation in patients over 75 years: a comparison with a younger cohort. Europace 2017;19:1798-1803.
Kanda T, Masuda M, Kurata N, et al. Efficacy and safety of the cryoballoon-based atrial fibrillation ablation in patients aged >/= 80 years. J Cardiovasc Electrophysiol. 2019;30:2242-2247.
Chao TF, Lin YJ, Chang SL, et al. Associations between renal function, atrial substrate properties and outcome of catheter ablation in patients with paroxysmal atrial fibrillation. Circ J. 2011;75:2326-2332.
Catanzariti D, Maines M, Angheben C, Centonze M, Cemin C, Vergara G. Usefulness of contrast intracardiac echocardiography in performing pulmonary vein balloon occlusion during cryo-ablation for atrial fibrillation. Indian Pacing Electrophysiol J. 2012;12:237-249.
Matsuda Y, Masuda M, Asai M, et al. A decapolar 25-mm-diameter circular mapping catheter with improved detection of pulmonary vein potential disappearance in cryoballoon ablation. J Arrhythm. 2019;35:535-541.
Iacopino S, Mugnai G, Takarada K, et al. Second-generation cryoballoon ablation without the use of real-time recordings: a novel strategy based on a temperature-guided approach to ablation. Heart Rhythm. 2017;14:322-328.
Aryana A, Mugnai G, Singh SM, et al. Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation. Heart Rhythm 2016;13:424-432.
Su W, Kowal R, Kowalski M, et al. Best practice guide for cryoballoon ablation in atrial fibrillation: the compilation experience of more than 3000 procedures. Heart Rhythm 2015;12:1658-1666.
Okumura Y, Watanabe I, Iso K, et al. Mechanistic insights into durable pulmonary vein isolation achieved by second-generation cryoballoon ablation. J Atr Fibrillation. 2017;9:1538-1538.
Chun KR, Schmidt B, Metzner A, et al. The ‘single big cryoballoon’ technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study. Eur Heart J. 2009;30:699-709.
Nolker G, Heintze J, Gutleben KJ, et al. Cryoballoon pulmonary vein isolation supported by intracardiac echocardiography: integration of a nonfluoroscopic imaging technique in atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2010;21:1325-1330.
Rubesch-Kutemeyer V, Molatta S, Vogt J, Gutleben KJ, Horstkotte D, Nolker G. Reduction of radiation exposure in cryoballoon ablation procedures: a single-centre study applying intracardiac echocardiography and other radioprotective measures. Europace 2017;19:947-953.
Schmidt M, Daccarett M, Marschang H, et al. Intracardiac echocardiography improves procedural efficiency during cryoballoon ablation for atrial fibrillation: a pilot study. J Cardiovasc Electrophysiol. 2010;21:1202-1207.
Hasegawa K, Miyazaki S, Kaseno K, et al. Pressure-guided second-generation cryoballoon pulmonary vein isolation: prospective comparison of the procedural and clinical outcomes with the conventional strategy. J Cardiovasc Electrophysiol. 2019;30:1841-1847.
Sunaga A, Masuda M, Asai M, et al. Pressure monitoring predicts pulmonary vein occlusion in cryoballoon ablation. J Interv Card Electrophysiol. 2018;53:115-121.
Lickfett L, Mahesh M, Vasamreddy C, et al. Radiation exposure during catheter ablation of atrial fibrillation. Circulation 2004;110:3003-3010.