Key result
Intracardiac echocardiography provided significantly higher imaging quality than intravascular ultrasound for pulmonary vein assessment, and acute wall thickening was observed after radiofrequency and laser ablation but not cryoablation.
Why the study?
Preliminary data suggested both ICE and IVUS provide real-time information on LA wall thickness and energy-induced tissue changes, but a direct comparison was needed.
Does intracardiac echocardiography provide better imaging quality and reproducibility compared to intravascular ultrasound for assessing left atrial wall thickness and acute tissue changes during pulmonary vein isolation?
Observational (n=12)
Blinded image analysis
No
Does intracardiac echocardiography provide better imaging quality and reproducibility compared to intravascular ultrasound for assessing left atrial wall thickness and acute tissue changes during pulmonary vein isolation?
Intracardiac echocardiography provides superior imaging quality and reproducibility compared to intravascular ultrasound for assessing acute left atrial wall changes during pulmonary vein isolation.
May support ICE preference for LA wall imaging in PVI; hypothesis-generating for ablation-specific tissue effects.
Introduction Preliminary data in human suggest that both Intracardiac echocardiography (ICE) and Intravascular ultrasound (IVUS) can be used for real-time information on the left atrial (LA) wall thickness and on the acute tissue changes produced by energy delivery. This pilot study was conducted to compare ICE and IVUS for real-time LA wall imaging and assessment of acute tissue changes produced by radiofrequency (RF), cryo and laser catheter ablation. Methods Patients scheduled for RF, cryoballoon or laser balloon Pulmonary Vein Isolation (PVI) catheter ablation were enrolled. Each pulmonary vein (PV) was imagedimmediately before and after ablation with either ICE or IVUS. The performance of ICE and IVUS for imaging were compared. Pre- and post-ablation measurements (lumen and vessel diameters, areas and sphericity indexes, wall thickness and muscular sleeve thickness) were taken at the level of each PV ostium.Results A total of 48 PVs in 12 patients were imaged before and after ablation. Compared to IVUS, ICE showedhigherimaging quality and inter-observer reproducibility of the PV measurements obtained. Acute wall thickening suggestive of oedema was observed after RF treatment (p = 0.003) and laser treatment (p = 0.003) but not after cryoablation (p = 0.69). Conclusions Our pilot study suggests that ICE is preferable to IVUS for LA wall thickness imaging at the LA-PV junctions during ablation. Ablation causes acute wall thickening when using RF or laser energy, but not cryoenergy delivery. Larger studies are needed to confirm these preliminary findings.
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Leo et al. (2021) conducted an observational in Paroxysmal atrial fibrillation (n=12). Intracardiac echocardiography (ICE) vs. Intravascular ultrasound (IVUS) was evaluated on Good imaging quality of pulmonary vein cross-sections (p=<0.001). Intracardiac echocardiography provided significantly higher imaging quality than intravascular ultrasound for pulmonary vein assessment, and acute wall thickening was observed after radiofrequency and laser ablation but not cryoablation.
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