Author + information
- Neil Brysiewicz, MS,
- Teferi Mitiku, MD,
- Kamran Haleem, MD,
- Paras Bhatt, MD,
- Mustapha Al-Shaaraoui, MD,
- Jude F. Clancy, MD,
- Mark A. Marieb, MD,
- Lissa Sugeng, MD and
- Joseph G. Akar, MD, PhD∗ ()
- Section of Cardiovascular Medicine, Division of Medicine, Yale University School of Medicine, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Joseph G. Akar, Section of Cardiovascular Medicine, Division of Medicine, Yale University School of Medicine, New Haven, Connecticut 06520.
cardiac imaging is critical for the success of interventional electrophysiological procedures. Fluoroscopy is highly beneficial for real-time catheter visualization, but it uses ionizing radiation and fails to provide detailed cardiac anatomy. Magnetic resonance imaging and computed tomography provide a high level of anatomic detail but no real-time visualization. The images shown here were obtained from intracardiac echocardiography (ICE) imaging (ACUSON AcuNav V ultrasound catheter and SC2000 imaging platform, Siemens Healthcare, Mountain View, California) in 3-dimensional (3D) mode in ablation. The interatrial septum; left atrial appendage; left superior, inferior, right superior, and inferior pulmonary veins (PVs); and esophagus were assessed. Imaging of left atrial anatomy was performed in real-time volume mode using a 90-cm, 10-F phased-array catheter capable of articulating 160° in 4 directions. Real-time imaging with a volume size of 22° × 90° was performed at 8-MHz frequency. The ICE catheter was placed in the lower RA unless otherwise specified. The still images (Figs. 1 to 6⇓⇓⇓⇓⇓⇓) and Online Videos 1 and 2 suggest that visualization of PV ostia is improved with volume ICE due to the ability to visualize the entire cross-sectional PV ostial diameter. Two-dimensional ICE provides only a “slice” through an individual PV ostium, which makes it impossible to assess its true anatomic extent in 3D space (1,2). In contrast, the azimuthal opening provided by volume ICE or “wider sector wedge” allows for visualization of the entire PV ostium with one view of the PV. This makes it significantly easier to assess the antrum of the PV and differentiate it from the true ostium, which should improve the safety of the procedure by reducing the risk of PV stenosis. Similarly, volume ICE visualization of the ridge between the left atrial appendage and left PVs is very easy, uniformly successful, and excellent in resolution when performed from the RA. Thus, the use of 3D mode eliminates the need for imaging from areas, such as the coronary sinus (CS) and right ventricular outflow tract (RVOT). This carries important practical implications regarding improving the ease of use of ICE, interpretation of images, and reducing procedure times. More importantly, it reduces the risk associated with ICE imaging from the CS and RVOT, including cardiac perforation, tamponade, and valve damage. Further studies on the use of volume ICE to increase efficacy, reduce ionizing radiation exposure, and decrease complications of atrial fibrillation ablation are needed.
For supplementary videos and their legends, please see the online version of this article.
Dr. Sugeng is a consultant for Phillips Healthcare, Siemens Healthcare, and TomTec. Dr. Mitiku has received honoraria for serving on the Speakers' Bureau of Medtronic. Dr. Bhatt has received honoraria for serving as a consultant for St. Jude Medical. Dr. Clancy has received honoraria for serving on the speakers' bureaus of Spectranetics, St. Jude Medical, and Boston Scientific and for serving as a proctor for Spectranetics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Kim S.S.,
- Hijazi Z.M.,
- Lang R.M.,
- Knight B.P.