1. Abstract: P1353
Impact of intracardiac echocardiography on electrical storm ablation
Authors:
F. Turreni1, A. Castro1, M.L. Loricchio1, M. Mercurio1, F. Messina1, G. Altamura1, 1Sandro Pertini Hospital,
CESC, UOC Cardiologia ­ Rome ­ Italy,
Topic(s):
Tools: catheters, sources, mapping, navigators (Catheter ablation /except atrial
Citation:
Europace Abstracts Supplement ( 2015 ) 17 ( Supplement 3 ), iii188
Electrical storm (ES)radiofrequency ablation (RFA) may involve complex anatomic structures or lead to fast
hemodynamic destabilization and major complications (MC) . Intracardiac Echocardiographic approach (ICE)
may speed detailed and complex 3D reconstruction and monitor complications. We retrospectively compared
ICE and standard contact mapping (SCM) impact on ES ablation.
19 ES pts (11 males, 9 ICE, 67 ± 6 y) underwent RFA from 2010 to 2015. We compared ICE to SCM in
terms of VT inducibility, procedural and fluoroscopy time and complications.
6 (60%) of SCM and 6 (66,7%) of ICE pts achieved complete VT noninducibility. ICE allowed pedunculated
aneurysm, false tendons, moderator band and sinotubular junction plaque (leading to switch from retrograde to
transeptal approach) visualization in 4 cases; increasing pericardial effusion with fibrin apposition in 1 (controlled
by heparin neutralization). procedural and fluoroscopy times were shorter in ICE. No MC happened in both
groups.
ICE may increase ES ablation effectiveness, decrease procedure duration and fluoroscopy time. ICE allowed
direct visualization and management of complex and risky anatomies and impending MC.
Table 1
SCM (10) ICE (9)
Males 6 (60%) 6 (66,7%)
Ischemic 6 (60%) 6 (66,7%)
Idiopathic 2 (20%) 2 (22,2%)
Myocarditis 0 1 (11,1%)
Dilated 2 (20%) 0
EF 34 ± 4% 41 ±6%
Transeptal approach 4 (40%) 4 (44,4%)
Negative PES 6 (60%) 6 (66,7%)
Complex/Risky anatomy ­ 4 (44,4%)
Fluoro / Procedural time 48 ± 25/248 ± 36 min 28 ± 20/201 ± 22min
Increasing Pericardial effusion 0 1 (11,1%)