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Review
. 2024 Aug;67(5):1257-1266.
doi: 10.1007/s10840-023-01699-2. Epub 2023 Nov 20.

Intracardiac echocardiography-guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience

Antonio Dello Russo  1   2 , Claudio Tondo  3 , Vincenzo Schillaci  4 , Michela Casella  5   6 , Saverio Iacopino  7 , Stefano Bianchi  8 , Gaetano Fassini  3 , Antonio Rossillo  9 , Paolo Compagnucci  5   10 , Marco Schiavone  3 , Armando Salito  4 , Ruggero Maggio  11 , Laura Cipolletta  5 , Sakis Themistoclakis  12 , Claudio Pandozi  13 , Pasquale Filannino  7 , Pietro Rossi  8 , Carlo Bonanno  9 , Quintino Parisi  5 , Maurizio Malacrida  14 , Francesco Solimene  10   4
Affiliations
Review

Intracardiac echocardiography-guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience

Antonio Dello Russo et al. J Interv Card Electrophysiol. 2024 Aug.

Abstract

Background: Intracardiac echocardiography (ICE) is increasingly employed in atrial fibrillation (AF) ablation procedures, with the potential to enhance procedural efficacy. Nevertheless, there is currently a lack of evidence assessing the impact of ICE on the efficiency, effectiveness, and safety outcomes in the context of novel pulsed-field ablation (PFA) for AF.

Purpose: We aimed to assess whether the use of ICE could improve procedural parameters in a large population undergoing AF ablation with FARAPULSE™ catheter.

Methods: Consecutive patients who had undergone PFA of AF from nine Italian centers were included. In procedures where the ICE catheter was employed for guidance (ICE-guided group), it was used to maneuver the PFA catheter within the left atrium to achieve optimal contact with atrial structures.

Results: We analyzed 556 patients: 357 (66%) with paroxysmal AF, 499 (89.7%) de novo PVI. ICE-guided procedures (n = 138) were propensity matched with patients with a standard approach (n = 138), and their outcomes were compared. During ICE-guided procedures, no improvement in procedural metrics was recorded (ICE vs Standard, 23 ± 6 min vs 18.5 ± 9 min for time to PVI, p < 0.0001; 38.8 ± 7 vs 32.5 ± 5 number of PFA deliveries to achieve PVI, p < 0.0001; 68.8 ± 19 min vs 71.8 ± 29 min for primary operator time, p = 0.5301; 16.1 ± 8 min vs 18.2 ± 10 min for fluoroscopy time, p = 0.5476) except for support time (76.8 ± 26 min vs 91.4 ± 37 min, p = 0.0046). No major procedure-related adverse events were reported.

Conclusion: Our findings confirmed that PFA could be consistently performed in a rapid, safe, and efficacious manner. The use of ICE to guide PFA was not associated with an improvement in procedural metrics.

Keywords: Atrial fibrillation; Electroporation; Intracardiac echocardiography; Pulsed-field ablation.

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