From Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, Mass (L.M.E., T.W.S.) and the University of Virginia School of
Medicine, Charlottesville (M.A.M., D.E.H.).
Correspondence to Laurence M. Epstein, MD, Division of Cardiology, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, Boston, MA 02215. E-mail lepstein{at}bidmc.harvard.edu
Background—Recently, attempts
have been made to cure atrial fibrillation by creating multiple linear
atrial lesions with radiofrequency energy. Intracardiac
echocardiography (ICE) offers imaging of
endocardial anatomy and the ablation electrode–tissue
interface not available with standard fluoroscopy. This study sought to
prospectively compare fluoroscopic with ICE guidance for the creation
of linear atrial lesions in a canine model.
Methods and Results—The creation of 3 linear atrial lesions was
attempted in each of 10 dogs, half guided by fluoroscopy alone and half
by ICE. Coil-tissue contact was prospectively graded. After ablation,
animals were euthanized, and the location and continuity of lesions
were evaluated. ICE guidance led to a higher percentage of successful
applications (P=0.02) and mean achieved temperature
(P=0.004). The contact scores of excellent, fair, and
poor correlated well with successful energy delivery, mean temperature,
and efficiency of heating (P<0.0001). In 25% of the
blinded energy deliveries, the location, as determined by the ablation
operator, differed from that of ICE. Pathological evaluation revealed
improved lesion formation in the ICE-guided compared with the
ICE-blinded group. Lesions were found outside the target areas in the
ICE-blinded but not the ICE-guided group.
Conclusions—Compared with fluoroscopy, ICE guidance improved
targeting, energy delivery, and lesion formation in this canine model.
This study suggests that ICE guidance improves lesion formation and
prevents energy delivery to potentially dangerous sites.
© 1998 American Heart Association, Inc.
Basic Science Reports
Comparative Study of Fluoroscopy and Intracardiac Echocardiographic Guidance for the Creation of Linear Atrial Lesions
Key Words: echocardiography • catheter ablation • atrial fibrillation
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