Ablation lesions in Koch's triangle assessed by three-dimensional myocardial contrast echocardiography.
BACKGROUND
Myocardial contrast echocardiography (MCE) allows visualization of radiofrequency (RF) ablation lesions in the left ventricle in an animal model.


OBJECTIVE
To test whether MCE allows visualization of RF and cryo ablation lesions in the human right atrium using three-dimensional echocardiography.


METHODS
18 patients underwent catheter ablation of a supraventricular tachycardia and were included in this prospective single-blind study. Twelve patients were ablated inside Koch's triangle and 6, who served as controls, outside this area. Three-dimensional echocardiography of Koch's triangle was performed before and after the ablation procedure in all patients, using respiration and ECG gated pullback of a 9 MHz ICE transducer, with and without continuous intravenous echocontrast infusion (SonoVue, Bracco). Two independent observers analyzed the data off-line.


RESULTS
MCE identified ablation lesions as a low contrast area within the normal atrial myocardial tissue. Craters on the endocardial surface were seen in 10 (83%) patients after ablation. Lesions were identified in 11 out of 12 patients (92%). None of the control patients were recognized as having been ablated. The confidence score of the independent echo reviewer tended to be higher when the number of applications increased.


CONCLUSIONS
1. MCE allows direct visualization of ablation lesions in the human atrial myocardium. 2. Both RF and cryo energy lesions can be identified using MCE.
Szili-Torok
Tamas
T
Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands. szilitorok@comunique.hu
Kimman
Geert-Jan
GJ
Scholten
Marcoen
M
Thornton
Andrew
A
Ten Cate
Folkert
F
Roelandt
Jos
J
Jordaens
Luc
L
D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016037:Single-Blind Method; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*
D003287:Contrast Media