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Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation.

Biermann J, Bode C, Asbach S - Cardiol Res Pract (2012)

Bottom Line: Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA) offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium.Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events.The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Angiology, University Hospital of Freiburg, Hugstetter Stra β e 55, 79106 Freiburg, Germany.

ABSTRACT
Accurate delineation of the variable left atrial anatomy is of utmost importance during anatomically based ablation procedures for atrial fibrillation targeting the pulmonary veins and possibly other structures of the atria. Intracardiac echocardiography allows real-time visualisation of the left atrium and adjacent structures and thus facilitates precise guidance of catheter-based ablation of atrial fibrillation. In patients with abnormal anatomy of the atria and/or the interatrial septum, intracardiac ultrasound might be especially valuable to guide transseptal access. Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA) offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium. Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events. The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

No MeSH data available.


Related in: MedlinePlus

Visualisation of the LA and its adjacent structures with 2D ICE. (a) Interatrial septum (IAS), left superior pulmonary vein (LSPV), and left inferior pulmonary vein (LIPV). (b) The Brockenbrough-curved needle (BCN) is advanced from the right atrium to the IAS for transseptal puncture guided by ICE. (c) After successful transseptal puncture tenting of the IAS and the tip of the BCN in the LA are seen. (d) Example of abnormal anatomy of the IAS. An aneurysmatic IAS can hamper transseptal puncture. Progress of transseptal puncture can easily be visualised by 2D ICE.
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fig1: Visualisation of the LA and its adjacent structures with 2D ICE. (a) Interatrial septum (IAS), left superior pulmonary vein (LSPV), and left inferior pulmonary vein (LIPV). (b) The Brockenbrough-curved needle (BCN) is advanced from the right atrium to the IAS for transseptal puncture guided by ICE. (c) After successful transseptal puncture tenting of the IAS and the tip of the BCN in the LA are seen. (d) Example of abnormal anatomy of the IAS. An aneurysmatic IAS can hamper transseptal puncture. Progress of transseptal puncture can easily be visualised by 2D ICE.

Mentions: The intracardiac position in the right atrium of the ICE catheter allows detailed visualisation of the LA due to close proximity to cardiac structures (Figure 1). This is of great importance, because accurate delineation of the variable anatomy of the LA and its adjacent structures is essential during an anatomically based approach of electrically isolating the PVs. Right atrium, right ventricle, and tricuspid valve are visualised in the so-called home view. By rotating the ICE catheter in a clockwise fashion the aortic valve, left ventricle and right ventricular outflow tract are in the field of view before the mitral valve and LA with the left atrial appendage appear. With more clockwise rotation the left superior pulmonary vein (LSPV) and left inferior pulmonary vein (LIPV) can be evaluated (Figure 1(a)). In a further posterior direction the oesophagus and right PVs are visualised. Intracardiac ultrasound also provides anatomic imaging of areas of special interest, for example, the Marshall ligament region or the lipomatous hypertrophy of the atrial septum. These hypertrophic structures can then be targeted for more aggressive energy delivery to create effective transmural PV isolation [25].


Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation.

Biermann J, Bode C, Asbach S - Cardiol Res Pract (2012)

Visualisation of the LA and its adjacent structures with 2D ICE. (a) Interatrial septum (IAS), left superior pulmonary vein (LSPV), and left inferior pulmonary vein (LIPV). (b) The Brockenbrough-curved needle (BCN) is advanced from the right atrium to the IAS for transseptal puncture guided by ICE. (c) After successful transseptal puncture tenting of the IAS and the tip of the BCN in the LA are seen. (d) Example of abnormal anatomy of the IAS. An aneurysmatic IAS can hamper transseptal puncture. Progress of transseptal puncture can easily be visualised by 2D ICE.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC3368317&req=5

fig1: Visualisation of the LA and its adjacent structures with 2D ICE. (a) Interatrial septum (IAS), left superior pulmonary vein (LSPV), and left inferior pulmonary vein (LIPV). (b) The Brockenbrough-curved needle (BCN) is advanced from the right atrium to the IAS for transseptal puncture guided by ICE. (c) After successful transseptal puncture tenting of the IAS and the tip of the BCN in the LA are seen. (d) Example of abnormal anatomy of the IAS. An aneurysmatic IAS can hamper transseptal puncture. Progress of transseptal puncture can easily be visualised by 2D ICE.
Mentions: The intracardiac position in the right atrium of the ICE catheter allows detailed visualisation of the LA due to close proximity to cardiac structures (Figure 1). This is of great importance, because accurate delineation of the variable anatomy of the LA and its adjacent structures is essential during an anatomically based approach of electrically isolating the PVs. Right atrium, right ventricle, and tricuspid valve are visualised in the so-called home view. By rotating the ICE catheter in a clockwise fashion the aortic valve, left ventricle and right ventricular outflow tract are in the field of view before the mitral valve and LA with the left atrial appendage appear. With more clockwise rotation the left superior pulmonary vein (LSPV) and left inferior pulmonary vein (LIPV) can be evaluated (Figure 1(a)). In a further posterior direction the oesophagus and right PVs are visualised. Intracardiac ultrasound also provides anatomic imaging of areas of special interest, for example, the Marshall ligament region or the lipomatous hypertrophy of the atrial septum. These hypertrophic structures can then be targeted for more aggressive energy delivery to create effective transmural PV isolation [25].

Bottom Line: Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA) offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium.Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events.The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Angiology, University Hospital of Freiburg, Hugstetter Stra β e 55, 79106 Freiburg, Germany.

ABSTRACT
Accurate delineation of the variable left atrial anatomy is of utmost importance during anatomically based ablation procedures for atrial fibrillation targeting the pulmonary veins and possibly other structures of the atria. Intracardiac echocardiography allows real-time visualisation of the left atrium and adjacent structures and thus facilitates precise guidance of catheter-based ablation of atrial fibrillation. In patients with abnormal anatomy of the atria and/or the interatrial septum, intracardiac ultrasound might be especially valuable to guide transseptal access. Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA) offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium. Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events. The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

No MeSH data available.


Related in: MedlinePlus