Circulation. 2003;107:2710-2716
Published online before print May 19, 2003, doi: 10.1161/01.CIR.0000070541.83326.15
Published online before print May 19, 2003, doi: 10.1161/01.CIR.0000070541.83326.15
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(Circulation. 2003;107:2710.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Phased-Array Intracardiac Echocardiography Monitoring During Pulmonary Vein Isolation in Patients With Atrial Fibrillation
Impact on Outcome and Complications
From the Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Andrea Natale, MD, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Desk F 15, 9500 Euclid Ave, Cleveland, OH 44195. E-mail natalea{at}ccf.org
Background— The objective of this study was to assess the impact of intracardiac echocardiography (ICE) on the long-term success and complications in patients undergoing pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF).
Methods and Results— Three hundred fifteen patients underwent PVI for treatment of AF. Each patient underwent ostial isolation of all PVs using a cooled-tip ablation catheter. PVI was performed using circular mapping (CM) alone (group 1, 56 patients), CM and ICE (group 2, 107 patients), and CM and ICE with titration of radiofrequency energy based on visualization of microbubbles by ICE (group 3, 152 patients). After a mean follow-up time of 417±145 days, 19.6% (11 of 56), 16.8% (18 of 107), and 9.8% (15 of 152) of patients in groups 1, 2, and 3 experienced recurrence of AF, respectively. Moreover, whereas no group 3 patient experienced severe (>70%) PV stenosis, severe PV stenosis was documented in 3 (3.5%) of 56 patients in group 1 and in 2 (1.8%) of 107 patients in group 2 (P<0.05). No embolic events were detected in group 3 patients.
Conclusions— Intracardiac echocardiography improves the outcome of cooled-tip PVI. Power adjustment guided by direct visualization of microbubble formation reduces the risk of PV stenosis and improves long-term cure.
Key Words: fibrillation, atrial • ablation • echocardiography
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A. Pacifico and P. D. Henry Ablation for atrial fibrillation: are cures really achieved? J. Am. Coll. Cardiol., June 2, 2004; 43(11): 1940 - 1942. [Abstract] [Full Text] [PDF]
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H. Nakagawa, H. Aoyama, K. J. Beckman, S. S. Po, R. Wu, D. Lockwood, P. Spector, J. D. Calame, D. L. Lustgarten, L. Herring, et al. Relation Between Pulmonary Vein Firing and Extent of Left Atrial-Pulmonary Vein Connection in Patients With Atrial Fibrillation Circulation, March 30, 2004; 109(12): 1523 - 1529. [Abstract] [Full Text] [PDF]
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M. S. Chen, N. F. Marrouche, Y. Khaykin, A. M. Gillinov, O. Wazni, D. O. Martin, A. Rossillo, A. Verma, J. Cummings, D. Erciyes, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1004 - 1009. [Abstract] [Full Text] [PDF]
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M. F. Scholten and L. J. Jordaens Catheter ablation of atrial fibrillation: still investigational or already an established therapy? Europace, January 1, 2004; 6(2): 79 - 82. [Full Text] [PDF]
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J. B Seward Fantastic voyage through the cardiovascular system Eur J Echocardiogr, January 1, 2004; 5(1): 8 - 11. [Full Text] [PDF]
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E. B. Saad, A. Rossillo, C. P. Saad, D. O. Martin, M. Bhargava, D. Erciyes, D. Bash, M. Williams-Andrews, S. Beheiry, N. F. Marrouche, et al. Pulmonary Vein Stenosis After Radiofrequency Ablation of Atrial Fibrillation: Functional Characterization, Evolution, and Influence of the Ablation Strategy Circulation, December 23, 2003; 108(25): 3102 - 3107. [Abstract] [Full Text] [PDF]
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R. W Troughton, C. R Asher, and A. L Klein The role of echocardiography in atrial fibrillation and cardioversion Heart, December 1, 2003; 89(12): 1447 - 1454. [Full Text] [PDF]
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O. Wazni, N. F. Marrouche, D. O. Martin, A. M. Gillinov, W. Saliba, E. Saad, A. Klein, M. Bhargava, D. Bash, R. Schweikert, et al. Randomized Study Comparing Combined Pulmonary Vein-Left Atrial Junction Disconnection and Cavotricuspid Isthmus Ablation Versus Pulmonary Vein-Left Atrial Junction Disconnection Alone in Patients Presenting With Typical Atrial Flutter and Atrial Fibrillation Circulation, November 18, 2003; 108(20): 2479 - 2483. [Abstract] [Full Text] [PDF]
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P. M. Kistler, P. Sanders, S. P. Fynn, I. H. Stevenson, A. Hussin, J. K. Vohra, P. B. Sparks, and J. M. Kalman Electrophysiological and Electrocardiographic Characteristics of Focal Atrial Tachycardia Originating From the Pulmonary Veins: Acute and Long-Term Outcomes of Radiofrequency Ablation Circulation, October 21, 2003; 108(16): 1968 - 1975. [Abstract] [Full Text] [PDF]
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A. M. Qureshi, L. R. Prieto, L. A. Latson, G. K. Lane, C. I. Mesia, P. Radvansky, R. D. White, N. F. Marrouche, E. B. Saad, D. L. Bash, et al. Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation Circulation, September 16, 2003; 108(11): 1336 - 1342. [Abstract] [Full Text] [PDF]
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L. Jordaens Treatment of atrial fibrillation by catheter-based procedures Europace, January 1, 2003; 5(s1): S30 - S35. [Abstract] [Full Text] [PDF]
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