Key result
ICE-guided CTI ablation linked to ~92% shorter fluoroscopy time versus fluoroscopy alone.
Why the study?
Intracardiac echocardiography (ICE) has been proposed to reduce radiation exposure during cavotricuspid isthmus (CTI) ablation, prompting a comparison of procedural parameters between ICE-guided and fluoroscopy-only procedures.
Does intracardiac echocardiography (ICE) guidance improve procedural outcomes and reduce radiation exposure in patients undergoing cavotricuspid isthmus ablation for typical atrial flutter compared to fluoroscopy-only guidance?
Cohort (n=370)
No
Does intracardiac echocardiography (ICE) guidance improve procedural outcomes and reduce radiation exposure in patients undergoing cavotricuspid isthmus ablation for typical atrial flutter compared to fluoroscopy-only guidance?
Absolute Event Rate: 73% vs 900%
p-value: p=<0.001
Intracardiac echocardiography guidance during cavotricuspid isthmus ablation for typical atrial flutter significantly reduces procedure time, ablation time, and radiation exposure without increasing complications.
May reduce radiation exposure in CTI ablation without added risk; leaves open need for randomized confirmation before practice change.
Atrial flutter (AFL) represents a prevalent variant of supraventricular tachycardia, distinguished by a macro-reentrant pathway encompassing the cavotricuspid isthmus (CTI). Radiofrequency (RF) catheter ablation stands as the favored therapeutic modality for managing recurring CTI-dependent AFL. Intracardiac echocardiography (ICE) has been proposed as a method to reduce radiation exposure during CTI ablation. This study aims to comprehensively compare procedural parameters between ICE-guided CTI ablation and fluoroscopy-only procedures. A total of 370 consecutive patients were enrolled in our single-center retrospective study. In 151 patients, procedures were performed using fluoroscopy guidance only, while 219 patients underwent ICE-guided CTI ablation. ICE guidance significantly reduced fluoroscopy time (73 (36; 175) s vs. 900 (566; 1179) s; p < 0.001), fluoroscopy dose (2.45 (0.6; 5.1) mGy vs. 40.5 (25.7; 62.9) mGy; p < 0.001), and total procedure time (70 (52; 90) min vs. 87.5 (60; 102.5) min; p < 0.001). Total ablation time (657 (412; 981) s vs. 910 (616; 1367) s; p < 0.001) and the time from the first to last ablation (20 (11; 36) min vs. 40 (25; 55) min; p < 0.01) were also significantly shorter in the ICE-guided group. Acute success rate was 100% in both groups, and no major complications occurred in either group. ICE-guided CTI ablation in patients with AFL resulted in shorter procedure times, reduced fluoroscopy exposure, and decreased ablation times, compared to the standard fluoroscopy-only approach.
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Turcsán et al. (2023) conducted a cohort in Atrial flutter (n=370). Intracardiac echocardiography (ICE) guidance vs. Fluoroscopy guidance only was evaluated on Fluoroscopy time (seconds) (p=<0.001). Intracardiac echocardiography guidance during cavotricuspidal isthmus ablation for atrial flutter significantly reduced median fluoroscopy time (73 vs 900 seconds) and total procedure time compared to fluoroscopy alone.
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