Clinical Trials Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2017; 9(6): 539-546
Published online Jun 26, 2017. doi: 10.4330/wjc.v9.i6.539
Catheter ablation of atrial fibrillation facilitated by preprocedural three-dimensional transesophageal echocardiography: Long-term outcome
Klaus Kettering, Felix Gramley, Stephan von Bardeleben
Klaus Kettering, Department of Cardiology, University of Frankfurt, 60590 Frankfurt, Germany
Felix Gramley, HPK Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, 69115 Heidelberg, Germany
Stephan von Bardeleben, Department of Cardiology, University of Mainz, 55131 Mainz, Germany
Author contributions: All authors have contributed significantly to this manuscript; they have made substantial contributions to the design of the study, to the acquisition of data and to the interpretation of the results; they have revised the manuscript critically for its scientific content; all authors have approved the final version of the manuscript; Kettering K and Gramley F contributed equally to this study.
Institutional review board statement: The study was compatible with the regulations issued by the reponsible University Review Board. No formal approval was required due to the retrospective charcater of the analysis.
Informed consent statement: All patients (or their legal guardians) gave informed consent prior to the ablation procedures.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Klaus Kettering, MD, Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. klaus.kettering@t-online.de
Telephone: +49-69-63017273 Fax: +49-69-63016457
Received: August 28, 2016
Peer-review started: August 30, 2016
First decision: October 8, 2016
Revised: March 12, 2017
Accepted: April 18, 2017
Article in press: April 20, 2017
Published online: June 26, 2017
Processing time: 301 Days and 4 Hours
Abstract
AIM

To evaluate the long-term outcome of catheter ablation of atrial fibrillation (AF) facilitated by preprocedural three-dimensional (3-D) transesophageal echocardiography.

METHODS

In 50 patients, 3D transesophageal echocardiography (3D TEE) was performed immediately prior to an ablation procedure (paroxysmal AF: 30 patients, persistent AF: 20 patients). The images were available throughout the ablation procedure. Two different ablation strategies were used. In most of the patients with paroxysmal AF, the cryoablation technique was used (Arctic Front Balloon, CryoCath Technologies/Medtronic; group A2). In the other patients, a circumferential pulmonary vein ablation was performed using the CARTO system [Biosense Webster; group A1 (paroxysmal AF), group B (persistent AF)]. Success rates and complication rates were analysed at 4-year follow-up.

RESULTS

A 3D TEE could be performed successfully in all patients prior to the ablation procedure and all four pulmonary vein ostia could be evaluated in 84% of patients. The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely (e.g., common pulmonary vein ostia, accessory pulmonary veins, varying diameter of the left atrial appendage and its distance to the left superior pulmonary vein). All ablation procedures could be performed as planned and almost all pulmonary veins could be isolated successfully. At 48-mo follow-up, 68.0% of all patients were free from an arrhythmia recurrence (group A1: 72.7%, group A2: 73.7%, group B: 60.0%). There were no major complications.

CONCLUSION

3D TEE provides an excellent overview over the left atrial anatomy prior to AF ablation procedures and these procedures are associated with a favourable long-term outcome.

Keywords: Pulmonary veins; Catheter ablation; Atrial fibrillation; Transesophageal echocardiography; Three-dimensional echocardiography

Core tip: Three-dimensional (3-D) transesophageal echocardiography has been shown to be a useful tool for analysing the individual left atrial morphology prior to an ablation procedure. The aim of this study was to evaluate whether favourable long-term results can be obtained by catheter ablation of atrial fibrillation after prior pulmonary vein imaging using 3-D transesophageal echocardiography. In 50 patients, 3-D transesophageal echocardiography was performed immediately prior to an ablation procedure. The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely. At 48-mo follow-up, 68.0% of all patients were free from an arrhythmia recurrence.