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Journal of Interventional Cardiac Electrophysiology

20-11-2023 | Atrial Fibrillation | REVIEW

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

Authors: Antonio Dello Russo, Claudio Tondo, Vincenzo Schillaci, Michela Casella, Saverio Iacopino, Stefano Bianchi, Gaetano Fassini, Antonio Rossillo, Paolo Compagnucci, Marco Schiavone, Armando Salito, Ruggero Maggio, Laura Cipolletta, Sakis Themistoclakis, Claudio Pandozi, Pasquale Filannino, Pietro Rossi, Carlo Bonanno, Quintino Parisi, Maurizio Malacrida, Francesco Solimene

Published in: Journal of Interventional Cardiac Electrophysiology

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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.
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Metadata
Title
Intracardiac echocardiography–guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience
Authors
Antonio Dello Russo
Claudio Tondo
Vincenzo Schillaci
Michela Casella
Saverio Iacopino
Stefano Bianchi
Gaetano Fassini
Antonio Rossillo
Paolo Compagnucci
Marco Schiavone
Armando Salito
Ruggero Maggio
Laura Cipolletta
Sakis Themistoclakis
Claudio Pandozi
Pasquale Filannino
Pietro Rossi
Carlo Bonanno
Quintino Parisi
Maurizio Malacrida
Francesco Solimene
Publication date
20-11-2023
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-023-01699-2
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