ABSTRACT
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 imaged immediately 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 showed higher imaging 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.
KEYWORDS: intracardiac echocardiography; intravascular
ultrasound; left atrial wall thickness; acute wall changes after
ablation; radiofrequency energy, cryoenergy, laser energy.
ABBREVIATIONS: AF = atrial fibrillation; ICE = Intracardiac
echocardiography; IQR = Interquartile range; IVUS= Intravascular
ultrasound; LA = Left atrial; PV = Pulmonary vein; PVI = Pulmonary vein
isolation; PVs = Pulmonary veins; RF= Radiofrequency; SD = Standard
deviation; WTI = Wall thickness index; WTI%= Wall thickness index
percentage.