Affiliation:
1. Heart Institute, Medical School, University of Pecs, H-7624 Pecs, Hungary
Abstract
Background: Atrioventricular node (AVN) ablation is an effective treatment for atrial fibrillation (AF) with uncontrolled ventricular rates despite maximal pharmacological treatment. Intracardiac echocardiography (ICE) can help with visualizing structures, positioning catheters, and guiding the ablation procedure. We compared only fluoroscopy-guided and ICE-guided AVN ablation regarding patients with permanent AF. Methods: Sixty-two consecutive patients underwent AVN ablation were enrolled in our retrospective single-center study (ICE group: 28 patients, Standard group: 34 patients). Procedural data, acute and long-term success rate, and complications were analyzed. Results: ICE guidance for AVN ablation significantly reduced fluoroscopy time (0.30 [0.06; 0.85] min vs. 7.95 [3.23; 6.59] min, p < 0.01), first-to-last ablation time (4 [2; 16.3] min vs. 26.5 [2.3; 72.5] min, p = 0.02), and in-procedure time (40 [34; 55] min vs. 60 [45; 110], p = 0.02). There was no difference in either the total ablation time (199 [91; 436] s vs. 294 [110; 659] s, p = 0.22) or in total ablation energy (8272 [4004; 14,651] J vs. 6065 [2708; 16,406] J, p = 0.28). The acute success rate was similar (ICE: 100% vs. Standard: 94%, p = 0.49) between the groups. Conclusions: In our retrospective trial, ICE-guided AVN ablation reduced fluoroscopy time, procedure time, and first-to-last ablation time. There was no difference in ablation time, total ablation energy, acute and long-term success, and complication rate.
Reference33 articles.
1. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS);Hindricks;Eur. Heart J.,2021
2. Pace and ablate better than drugs in patients with heart failure and atrial fibrillation: Lessons from the APAF-CRT mortality trial;Linde;Eur. Heart J.,2021
3. The 1998 NASPE Prospective Catheter Ablation Registry;Scheinman;Pacing Clin. Electrophysiol.,2000
4. A review on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation;Vlachos;J. Geriatr. Cardiol.,2015
5. National Research Council (2006). BEIR VII: Health Risks from Exposure to Low Levels of Ionizing Radiation: Report in Brief, National Academies. Available online: https://nap.nationalacademies.org/resource/11340/beir_vii_final.pdf.