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. 2012:2012:921746.
doi: 10.1155/2012/921746. Epub 2012 May 29.

Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation

Jürgen Biermann  1 , Christoph Bode, Stefan Asbach
Affiliations

Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation

Jürgen Biermann et al. Cardiol Res Pract. 2012.

Abstract

Accurate delineation of the variable left atrial anatomy is of utmost importance during anatomically based ablation procedures for atrial fibrillation targeting the pulmonary veins and possibly other structures of the atria. Intracardiac echocardiography allows real-time visualisation of the left atrium and adjacent structures and thus facilitates precise guidance of catheter-based ablation of atrial fibrillation. In patients with abnormal anatomy of the atria and/or the interatrial septum, intracardiac ultrasound might be especially valuable to guide transseptal access. Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA) offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium. Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events. The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

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Figures

Figure 1
Figure 1
Visualisation of the LA and its adjacent structures with 2D ICE. (a) Interatrial septum (IAS), left superior pulmonary vein (LSPV), and left inferior pulmonary vein (LIPV). (b) The Brockenbrough-curved needle (BCN) is advanced from the right atrium to the IAS for transseptal puncture guided by ICE. (c) After successful transseptal puncture tenting of the IAS and the tip of the BCN in the LA are seen. (d) Example of abnormal anatomy of the IAS. An aneurysmatic IAS can hamper transseptal puncture. Progress of transseptal puncture can easily be visualised by 2D ICE.
Figure 2
Figure 2
(a) ICE fan with overlying CT reconstruction of the LA in the anterior-posterior projection and (b) a completed reconstruction of the LA in posterior-anterior projection both using CARTOSound and the integrated software algorithm CARTOMerge.
Figure 3
Figure 3
Reconstruction of left pulmonary veins (a and b) and right pulmonary veins (c and d) using ICE in combination with the integrated software algorithm CARTOMerge. A dedicated ICE probe provides real-time anatomic images that are integrated with preprocedural acquired CT images. On ECG-gated ICE images, the anatomy of the PVs can be annotated (a and c), creating a 3D shell, and subsequently is integrated with the dedicated algorithm (b and d).
Figure 4
Figure 4
Three-dimensional ultrasound reconstruction of left atrial anatomy. (a) Minimal number of three ICE fans. (b) CARTOSound merge of three ICE fans with CT reconstruction of the LA. (c) Same LA with additional ICE fans of the body of the LA and all PVs. (d) CT reconstruction of the LA overlying all ICE fans (no further adjustment of LA orientation has been made).
Figure 5
Figure 5
(a) A mobile thrombus (white arrow) is attached to the tip of the transseptal sheath in the LA before the advancement of a catheter and before heparin administration. (b) A circular mapping catheter can clearly be visualised in the antrum of the LSPV. Attached to the inferior part of the ring of electrodes a mobile thrombus (white arrow) can be detected (reproduction kindly permitted by the publisher [18]).
See this image and copyright information in PMC

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