title: Phased-array intracardiac echocardiography monitoring during pulmonary vein isolation in patients with atrial fibrillation: impact on outcome and complications.
abstract: BACKGROUND
  The objective of this study was to assess the impact of intracardiac echocardiography (ICE) on the long-term success and complications in patients undergoing pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF).
  
  
  RESULTS
  Three hundred fifteen patients underwent PVI for treatment of AF. Each patient underwent ostial isolation of all PVs using a cooled-tip ablation catheter. PVI was performed using circular mapping (CM) alone (group 1, 56 patients), CM and ICE (group 2, 107 patients), and CM and ICE with titration of radiofrequency energy based on visualization of microbubbles by ICE (group 3, 152 patients). After a mean follow-up time of 417+/-145 days, 19.6% (11 of 56), 16.8% (18 of 107), and 9.8% (15 of 152) of patients in groups 1, 2, and 3 experienced recurrence of AF, respectively. Moreover, whereas no group 3 patient experienced severe (>70%) PV stenosis, severe PV stenosis was documented in 3 (3.5%) of 56 patients in group 1 and in 2 (1.8%) of 107 patients in group 2 (P<0.05). No embolic events were detected in group 3 patients.
  
  
  CONCLUSIONS
  Intracardiac echocardiography improves the outcome of cooled-tip PVI. Power adjustment guided by direct visualization of microbubble formation reduces the risk of PV stenosis and improves long-term cure.
authors.affiliation: Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Allan
authors.initials: A
authors.lastname: Klein
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.forename: Eduardo
authors.initials: E
authors.lastname: Saad
authors.forename: Dianna
authors.initials: D
authors.lastname: Bash
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Yamada
authors.forename: Wael
authors.initials: W
authors.lastname: Jaber
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.forename: Ahmad
authors.initials: A
authors.lastname: Abdul-Karim
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D018572:Disease-Free Survival; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D012008:Recurrence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods