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. 2014 Dec;100(23):1871-7.
doi: 10.1136/heartjnl-2014-306067. Epub 2014 Jul 31.

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation

Benjamin A Steinberg  1 , Bradley G Hammill  2 , James P Daubert  1 , Tristram D Bahnson  1 , Pamela S Douglas  1 , Laura G Qualls  2 , Sean D Pokorney  1 , Hugh Calkins  3 , Lesley H Curtis  2 , Jonathan P Piccini  1
Affiliations

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation

Benjamin A Steinberg et al. Heart. 2014 Dec.

Abstract

Objective: Catheter ablation of atrial fibrillation (AF) has become an increasingly safe and effective therapy. This has been partly attributed to the use of adjunctive imaging modalities. We aimed to describe the use and associated outcomes of periprocedural imaging for AF ablation.

Methods: We studied all Medicare fee-for-service claims for AF ablation from July 2007 to December 2009, and identified associated imaging studies before and during ablation, including transoesophageal echocardiography (TEE), intracardiac echocardiography (ICE), CT and MRI. The primary outcomes were death, stroke or transient ischaemic attack (TIA), repeat ablation, and bleeding (pericardial or vascular) at 6 months.

Results: 11 525 patients underwent AF ablation during the study period. There was significant variation in imaging use at the practice level. In addition to electroanatomic mapping, 53% (n=6060/11 525) underwent TEE, 67% (n=7715/11 525) received ICE, and 50% (n=5724/11 525) underwent a preprocedure CT or MRI. Imaging generally increased from 2007 to 2009. After adjustment, the use of preablation CT or MRI was associated with a significantly lower risk of stroke or TIA (0.4% vs 0.9%, adjusted HR 0.46, 95% CI 0.28 to 0.74, p=0.002), and the use of ICE was associated with a lower risk of repeat ablation (5.7% vs 8.5%, adjusted HR 0.59, 95% CI 0.37 to 0.92, p=0.02) but higher risk of bleeding (1.1% vs 0.7%, adjusted HR 1.76, 95% CI 1.15 to 2.70, p=0.009).

Conclusions: Periprocedural imaging for AF ablation is increasingly used, although practice patterns vary widely. Our data suggest that periprocedural imaging is associated with better outcomes after catheter ablation; however, prospective studies of periprocedural imaging strategies are warranted.

Keywords: QUALITY OF CARE AND OUTCOMES.

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Figures

Figure 1
Figure 1
Timing of preprocedural imaging before atrial fibrillation ablation. TEE, transoesophageal echocardiogram.
Figure 2
Figure 2
Practice variation in utilisation of periprocedural imaging modalities. For each imaging modality (CT/MRI, TEE, ICE), the use of imaging is plotted on the x-axis (% of ablations where the modality is used) and the proportion of practices using the modality at the corresponding rate is on the y-axis. Practices determined by 5-digit ZIP code; only those with ≥5 ablations in the study cohort were included here (n=337 providers). TEE, transoesophageal echocardiogram; ICE, intracardiac echocardiography.
Figure 3
Figure 3
Temporal trends in imaging utilisation before (CT, MRI, TEE) and during (ICE) atrial fibrillation ablation. TEE, transoesophageal echocardiogram; ICE, intracardiac echocardiography.
See this image and copyright information in PMC

References

    1. Piccini JP, Lopes RD, Kong MH, et al. Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials. Circ Arrhythm Electrophysiol. 2009;2:626–33. - PubMed
    1. Cappato R, Calkins H, Chen SA, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:32–8. - PubMed
    1. Blomstrom Lundqvist C, Auricchio A, Brugada J, et al. The use of imaging for electrophysiological and devices procedures: a report from the first European Heart Rhythm Association Policy Conference, jointly organized with the European Association of Cardiovascular Imaging (EACVI), the Council of Cardiovascular Imaging and the European Society of Cardiac Radiology. Europace. 2013;15:927–36. - PubMed
    1. Bunch TJ, Day JD. Examining the risks and benefits of transesophageal echocardiogram imaging during catheter ablation for atrial fibrillation. Circ Arrhythm Electrophysiol. 2012;5:621–3. - PubMed
    1. Ferguson JD, Helms A, Mangrum JM, et al. Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol. 2009;2:611–19. - PMC - PubMed

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