Randomized trial of intracardiac echocardiography during cavotricuspid isthmus ablation.
Randomized Trial of ICE During CTI Ablation.


BACKGROUND
Despite a high success rate, radio-frequency ablation (RFA) of the cavotricuspid isthmus (CTI) can be unusually challenging in some cases. We postulated that visualization of the CTI with intracardiac echocardiography (ICE) could maximize the success rate, decrease the procedure and ablation time, and minimize the radiation exposure.


RESULTS
In our prospective, randomized study, we included 102 patients scheduled for CTI ablation. We randomized patients in 2 groups: guided only by fluoroscopy (n = 52) or ICE-guided (n =50) group. Procedure time, fluoroscopy time, and the time spent for RFA were significantly shorter, radiation exposure (dose-area product-DAP) and the sum of delivered radio frequency energy were significantly lower in the ICE-group (68.06 ± 15.09 minutes vs 105.94 ± 36.51 minutes, P < 0.001, 5.54 ± 3.77 minutes vs 18.63 ± 10.60 minutes, P <0.001, 482.80 ± 534.12 seconds vs 779.76 ± 620.82 seconds, P = 0.001 and 397.62 ± 380.81 cGycm(2) vs 1,312.92 ± 1,129.28 cGycm(2) , P < 0.001, 10,866.84 ± 6,930.84 Ws vs 16,393.56 ± 13,995.78 Ws, P = 0.048, respectively). Seven patients (13%) from the fluoroscopy-only group crossed over to ICE-guidance because of prolonged unsuccessful RFA and were all treated successfully. Four vascular complications and 2 recurrences were equally distributed between the 2 groups.


CONCLUSIONS
ICE-guided ablation of the CTI significantly shortens the procedure and fluoroscopy time, markedly decreases radiation exposure, and time spent for ablation in comparison with fluoroscopy-only procedures. At the same time, visualization with ICE allowed successful ablation in challenging cases. (J Cardiovasc Electrophysiol, Vol. 23, pp. 996-1000, September 2012).
Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary. blackdoor@t-online.hu
Gábor
G
Bencsik
Róbert
R
Pap
Attila
A
Makai
Gergely
G
Klausz
Számi
S
Chadaide
Vassil
V
Traykov
Tamás
T
Forster
László
L
Sághy
D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D018592:Cross-Over Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D014261:Tricuspid Valve / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery*