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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

(a) A mobile thrombus (white arrow) is attached to the tip of the transseptal sheath in the LA before the advancement of a catheter and before heparin administration. (b) A circular mapping catheter can clearly be visualised in the antrum of the LSPV. Attached to the inferior part of the ring of electrodes a mobile thrombus (white arrow) can be detected (reproduction kindly permitted by the publisher [18]).
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fig5: (a) A mobile thrombus (white arrow) is attached to the tip of the transseptal sheath in the LA before the advancement of a catheter and before heparin administration. (b) A circular mapping catheter can clearly be visualised in the antrum of the LSPV. Attached to the inferior part of the ring of electrodes a mobile thrombus (white arrow) can be detected (reproduction kindly permitted by the publisher [18]).

Mentions: Usually thrombus formations form on the transseptal sheaths or the mapping/ablation catheters [18, 46] and are often found when activated clotting time is less than 300 seconds (Figure 5). While such findings may not affect specific acute intervention, they often have led to a change in anticoagulation protocols during the procedures. Administration of heparin before transseptal access is safe and minimises the risk of formation of clots on the sheaths or catheters [18, 19]. After successful transseptal puncture, the sheaths are flushed continuously with heparinized saline and the activated coagulation time is maintained between 300 and 400 seconds throughout the procedure [18]. In 90% of patients with real-time ICE-detected left atrial thrombus, successful withdrawal of the thrombus-attached catheters/sheaths from the LA into the right atrium has been reported to prevent any serious systemic embolic consequences [46].


Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation.

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

(a) A mobile thrombus (white arrow) is attached to the tip of the transseptal sheath in the LA before the advancement of a catheter and before heparin administration. (b) A circular mapping catheter can clearly be visualised in the antrum of the LSPV. Attached to the inferior part of the ring of electrodes a mobile thrombus (white arrow) can be detected (reproduction kindly permitted by the publisher [18]).
© Copyright Policy
Related In: Results  -  Collection

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

fig5: (a) A mobile thrombus (white arrow) is attached to the tip of the transseptal sheath in the LA before the advancement of a catheter and before heparin administration. (b) A circular mapping catheter can clearly be visualised in the antrum of the LSPV. Attached to the inferior part of the ring of electrodes a mobile thrombus (white arrow) can be detected (reproduction kindly permitted by the publisher [18]).
Mentions: Usually thrombus formations form on the transseptal sheaths or the mapping/ablation catheters [18, 46] and are often found when activated clotting time is less than 300 seconds (Figure 5). While such findings may not affect specific acute intervention, they often have led to a change in anticoagulation protocols during the procedures. Administration of heparin before transseptal access is safe and minimises the risk of formation of clots on the sheaths or catheters [18, 19]. After successful transseptal puncture, the sheaths are flushed continuously with heparinized saline and the activated coagulation time is maintained between 300 and 400 seconds throughout the procedure [18]. In 90% of patients with real-time ICE-detected left atrial thrombus, successful withdrawal of the thrombus-attached catheters/sheaths from the LA into the right atrium has been reported to prevent any serious systemic embolic consequences [46].

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