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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1510889
This article is part of the Research Topic Personalized Care in Cardiac Arrhythmias: the Role of Digital Platforms in Cardiac Arrhythmia Management View all 5 articles

Safety and Efficacy of Intracardiac Echocardiography ICE-Guided Zero-Fluoroscopy Ablation in Atrial Fibrillation Patients: A Comparative Study of High-Power Short-Duration and Low-Power Long-Duration Strategies

Provisionally accepted
Guangan Liu Guangan Liu Bo Shao Bo Shao Wanglong Wu Wanglong Wu Linxiao Zhou Linxiao Zhou Jing Cui Jing Cui Wenxue Chen Wenxue Chen Ruoxi Zhang Ruoxi Zhang Feng Liu Feng Liu *
  • Suzhou Kowloon Hospital, Suzhou, China

The final, formatted version of the article will be published soon.

    Introduction: In atrial fibrillation (AF) ablation, fluoroscopy has been a standard tool for catheter guidance. However, the combination of electroanatomic mapping systems (EAMs) and intracardiac echocardiography (ICE) now allows for minimal or zerofluoroscopy procedures. Concurrently, high-power short-duration (HPSD) ablation has emerged as a promising technique, offering enhanced resistive heating while reducing conductive heating. This approach potentially improves both safety and efficacy. Despite these advancements, there is a lack of comprehensive clinical data on the safety and effectiveness of HPSD ablation when used in conjunction with ICE-guided zerofluoroscopy procedures.Objective: To compare two different ablation strategies-high-power short-duration (HPSD) and low-power long-duration (LPLD)-both utilizing intracardiac echocardiography (ICE)-guided zero-fluoroscopy in the context of atrial fibrillation (AF) ablation.Methods: This retrospective study included 173 consecutive patients with AF who underwent ICE-guided zero-fluoroscopy ablation. Patients were divided into two groups: HPSD and LPLD. All procedures were conducted using an EAM system with ICE guidance. Both groups underwent routine pulmonary vein isolation (PVI), with additional linear ablations performed for persistent AF when necessary. We compared treatment outcomes and the incidence of complications between the two groups.Results: All procedures were successfully completed under ICE-guided zerofluoroscopy, establishing a feasible and reliable workflow. The procedure and ablation times were significantly shorter in the HPSD group compared to the LPLD group. At one-year follow-up, sinus rhythm was maintained in 77 patients in the HPSD group and 74 patients in the LPLD group, with no significant difference between the two group.Postoperative complications occurred in 5 patients in the HPSD group and 3 patients in the LPLD group. Importantly, there were no major adverse cardiac and cerebrovascular events (MACCE) in either group.A zero-fluoroscopy workflow utilizing an EAM system combined with ICE appears to be both feasible and safe for ablation in AF patients. In patients undergoing ICE-guided zero-fluoroscopy ablation, the HPSD strategy is comparable to LPLD ablation in effectiveness while offering the benefit of shorter procedure and ablation times.

    Keywords: Zero-fluoroscopy, Intracardiac echocardiography, high-power shortduration, Atrial Fibrillation, Radiofrequency ablation

    Received: 14 Oct 2024; Accepted: 07 Nov 2024.

    Copyright: © 2024 Liu, Shao, Wu, Zhou, Cui, Chen, Zhang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Feng Liu, Suzhou Kowloon Hospital, Suzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.