Abstract 19694: Adjunct Intracardiac Echocardiography is Associated With Reduced Fluoroscopy and Procedural Time in the Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter
Introduction: With the routine use of contact force-sensing ablation catheters, the additional utility of intracardiac echocardiography (ICE) in the ablation of typical right atrial flutter (AFL) is unclear. We sought to characterize the impact of ICE during AFL ablation on fluoroscopy and procedural times, safety, and clinical recurrence.
Hypothesis: We hypothesized that adjunctive ICE use may improve ablation outcomes.
Methods: We performed a retrospective observational cohort study in which consecutive cases utilizing ICE at the outset of AFL ablation (ICE+) were compared against those in which ICE was not used at the outset (ICE-) from 2014-15. All cases utilized electroanatomical mapping and a contact force-sensing ablation catheter. Cases were excluded if patients had congenital heart disease or if arrhythmias other than AFL were induced or targeted. Statistical comparisons were unadjusted.
Results: ICE+ (n=23) were compared to ICE- (n=28) cases. There were no procedural complications in either arm. ICE+ was associated with reduced fluoroscopy use (7.8 ± 6.2 min vs. 14.4 ± 10.4 min, p < 0.01) and faster time to bidirectional block (33 ± 20 min vs. 59 ± 34 min, p = 0.0001). In 8/28 (29%) of ICE- cases, initial difficulty in achieving bidirectional block ultimately prompted ICE use later in the procedure. These cases were associated with additional fluoroscopy use (16.8 ± 10.1 min vs. 7.8 ± 6.2 min, p < 0.01) and longer times to bidirectional block (101 ± 28 min vs. 33 ± 20 min, p < 0.0001) compared to upfront ICE+ cases. There was one clinical recurrence of atrial arrhythmias in each arm of the study.
Conclusions: Routine use of ICE at the outset of AFL ablation may shorten procedural times and reduce the need for fluoroscopy. Additional studies with randomization and multivariable adjustment for potential confounders are required to determine whether ICE positively impacts other safety endpoints and long term procedural efficacy.
Author Disclosures: M.M. Zipse: None. W.H. Sauer: Research Grant; Modest; Receives significant research grants from Biosense Webster and CardioNXT and educational grants from St Jude Medical, Boston Scientific, and Medtronic. Ownership Interest; Modest; Has non-public equity interests/stock options in CardioNXT. Other; Modest; Has a provisional patent on partially insulated focused catheter ablation. J.E. Gonzalez: None. C. Tompkins: Research Grant; Significant; Colorado Center for Women’s Health Research. Other Research Support; Modest; Medtronic. Consultant/Advisory Board; Modest; Spectranetics. R.G. Aleong: None. P.D. Varosy: None. J.L. Schuller: None. D.T. Nguyen: Research Grant; Modest; Receives significant research grants from Biosense Webster and CardioNXT and educational grants from St Jude Medical, Boston Scientific, and Medtronic. Ownership Interest; Modest; Has non-public equity interests/stock options in CardioNXT. Other; Modest; Has a provisional patent on partially insulated focused catheter ablation. W.S. Tzou: None.
- © 2016 by American Heart Association, Inc.