title: Utility of intracardiac echocardiography for catheter ablation of complex cardiac arrhythmias in a medium-volume training center.
abstract: OBJECTIVE
  New electrophysiology tools like intracardiac echocardiography (ICE) might help to minimize and early detect complications during cardiac ablation procedures. The aim of the study was to assess the utility and vascular safety of ICE during catheter ablation of complex cardiac arrhythmias in a medium-volume training center.
  
  
  METHODS
  Prospective, observational study consisted of consecutive patients who underwent catheter-based ablation of complex cardiac arrhythmias. All procedures were performed using three-dimensional electro-anatomical mapping and routine cannulation of right and left femoral veins. The ICE probe was initially positioned at the mid-level of the right atrium and properly moved to monitor different steps of the procedure and identify complications. All procedure-related vascular complications were registered.
  
  
  RESULTS
  One hundred two patients (age 61.4 ± 13.1 years, 69 male) underwent 110 ablation procedures. Pulmonary vein isolation was the most common ablation substrate (55.4%). Ventricular tachycardia (17.2%) and left atrial flutter procedures (16.4%) were also common. The use of ICE enabled us to early initiate anticoagulation and to optimize the transseptal puncture. It also provided the capability to early detect life-threatening complications such as tamponade (3.6%), along with important information during the procedure such as exact catheter location, lesion formation, and stability during radiofrequency delivery. Such benefits were not associated with a higher number of vascular complications.
  
  
  CONCLUSIONS
  The use of ICE during catheter-based ablation of complex cardiac substrates provides technical features that may decrease complications and increase accuracy while applying radiofrequency, especially in training centers where fellows start to perform complex procedures.
authors.affiliation: Department of Cardiology, La Paz University Hospital, Madrid, Spain; Atherothrombosis, Imaging and Epidemiology Department, National Center for Cardiovascular Research (CNIC), Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Filgueiras-Rama
authors.forename: Fernando
authors.initials: F
authors.lastname: de Torres-Alba
authors.forename: Sergio
authors.initials: S
authors.lastname: Castrejón-Castrejón
authors.forename: Alejandro
authors.initials: A
authors.lastname: Estrada
authors.forename: Jorge
authors.initials: J
authors.lastname: Figueroa
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Salvador-Montañés
authors.forename: Teresa
authors.initials: T
authors.lastname: López
authors.forename: Mar
authors.initials: M
authors.lastname: Moreno-Yanguela
authors.forename: José L
authors.initials: JL
authors.lastname: López Sendón
authors.forename: José L
authors.initials: JL
authors.lastname: Merino
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000601:surgery*; D002309:Cardiology / Q000193:education; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D004493:Education; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011871:Radiology / Q000193:education; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: ablation; complex arrhythmias; complications; intracardiac echocardiography