Abstract 2455: 3D Transesophageal Ultrasound for Real-Time Guidance of Atrial Fibrillation Ablations
Introduction: The inherent limitations of 3D mapping systems such as the simplified anatomy, registration errors, and the inability to reliably assess catheter contact or complications make real-time imaging a desirable component for atrial fibrillation (AF) ablations.
Methods: Nine patients (4 men, 62±11 years) underwent ablation for paroxysmal (n=5) or persistent AF (n=4). Preprocedural and periprocedural imaging was performed using a Philips 3D TEE system to rule out left atrial appendage (LAA) thrombus and guide transseptal puncture as well as ablation along critical sites (left superior pulmonary vein (LSPV)/LAA isthmus and left and right PV carina).
Results: 3D ultrasound was able to identify the relevant LA anatomy in all patients and successfully ruled out LAA thrombus. Tenting of foramen ovale and transseptal puncture was successfully guided by 3D TEE. 3D ultrasound identified pulmonary vein (PV) os and proximal PV anatomy and allowed accurate placement of circular Lasso catheters. 3D ultrasound was able to confirm continuous catheter contact during the ablation of critical areas such as the LSPV/LAA isthmus and left/right PV carina (Figure⇓) and demonstrated position errors of ≥5mm with current 3D mapping systems using image integration. No complications occurred during the ablations. At 5±2 months follow-up two patients had recurrent AF off antiarrhythmics.
Conclusions: 3D ultrasound is able to provide unique anatomic real-time guidance during AF ablations and guide catheter contact at critical anatomic structures. This suggests a role of 3D US in minimizing position errors inherent to 3D mapping systems and may result in improved procedural success.