Intracardiac Echocardiography

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Luc Jordaens - One of the best experts on this subject based on the ideXlab platform.

Andrea Natale - One of the best experts on this subject based on the ideXlab platform.

Gennaro Santoro - One of the best experts on this subject based on the ideXlab platform.

  • clinical researchstructuralperiprocedural Intracardiac Echocardiography for left atrial appendage closure a dual center experience
    Jacc-cardiovascular Interventions, 2014
    Co-Authors: Sergio Berti, Umberto Paradossi, Francesco Meucci, Giuseppe Trianni, Apostolos Tzikas, Marco Rezzaghi, Miroslava Stolkova, Cataldo Palmieri, Fabio Mori, Gennaro Santoro
    Abstract:

    Objectives This dual-center study sought to demonstrate the utility and safety of Intracardiac Echocardiography (ICE) in providing adequate imaging guidance as an alternative to transesophageal Echocardiography (TEE) during Amplatzer Cardiac Plug device implantation.

  • periprocedural Intracardiac Echocardiography for left atrial appendage closure a dual center experience
    Jacc-cardiovascular Interventions, 2014
    Co-Authors: Sergio Berti, Umberto Paradossi, Francesco Meucci, Giuseppe Trianni, Apostolos Tzikas, Marco Rezzaghi, Miroslava Stolkova, Cataldo Palmieri, Fabio Mori, Gennaro Santoro
    Abstract:

    Abstract Objectives This dual-center study sought to demonstrate the utility and safety of Intracardiac Echocardiography (ICE) in providing adequate imaging guidance as an alternative to transesophageal Echocardiography (TEE) during Amplatzer Cardiac Plug device implantation. Background Over 90% of Intracardiac thrombi in atrial fibrillation originate from the left atrial appendage (LAA). Patients with contraindications to anticoagulation are potential candidates for LAA percutaneous occlusion. TEE is typically used to guide implantation. Methods ICE-guided percutaneous LAA closure was performed in 121 patients to evaluate the following tasks typically achieved by TEE: assessment of the LAA dimension for device sizing; guidance of transseptal puncture; verification of the delivery sheath position; confirmation of location and stability of the device before and after release and continuous monitoring to detect procedural complications. In 51 consecutive patients, we compared the measurements obtained by ICE and fluoroscopy to choose the size of the device. Results The device was successfully implanted in 117 patients, yielding a technical success rate of 96.7%. Procedural success was achieved in 113 cases (93.4%). Four major adverse events (3 cardiac tamponades and 1 in-hospital transient ischemic attack) occurred. There was significant correlation in the measurements for device sizing assessed by angiography and ICE (r = 0.94, p  Conclusions ICE imaging was able to perform the tasks typically provided by TEE during implantation of the Amplatzer Cardiac Plug device for LAA occlusion. Therefore, we provide evidence that the use of ICE offered accurate measurements of LAA dimension in order to select the correct device sizes.

  • periprocedural Intracardiac Echocardiography for left atrial appendage closure a dual center experience
    Jacc-cardiovascular Interventions, 2014
    Co-Authors: Sergio Berti, Umberto Paradossi, Francesco Meucci, Giuseppe Trianni, Apostolos Tzikas, Marco Rezzaghi, Miroslava Stolkova, Cataldo Palmieri, Fabio Mori, Gennaro Santoro
    Abstract:

    Abstract Objectives This dual-center study sought to demonstrate the utility and safety of Intracardiac Echocardiography (ICE) in providing adequate imaging guidance as an alternative to transesophageal Echocardiography (TEE) during Amplatzer Cardiac Plug device implantation. Background Over 90% of Intracardiac thrombi in atrial fibrillation originate from the left atrial appendage (LAA). Patients with contraindications to anticoagulation are potential candidates for LAA percutaneous occlusion. TEE is typically used to guide implantation. Methods ICE-guided percutaneous LAA closure was performed in 121 patients to evaluate the following tasks typically achieved by TEE: assessment of the LAA dimension for device sizing; guidance of transseptal puncture; verification of the delivery sheath position; confirmation of location and stability of the device before and after release and continuous monitoring to detect procedural complications. In 51 consecutive patients, we compared the measurements obtained by ICE and fluoroscopy to choose the size of the device. Results The device was successfully implanted in 117 patients, yielding a technical success rate of 96.7%. Procedural success was achieved in 113 cases (93.4%). Four major adverse events (3 cardiac tamponades and 1 in-hospital transient ischemic attack) occurred. There was significant correlation in the measurements for device sizing assessed by angiography and ICE (r = 0.94, p  Conclusions ICE imaging was able to perform the tasks typically provided by TEE during implantation of the Amplatzer Cardiac Plug device for LAA occlusion. Therefore, we provide evidence that the use of ICE offered accurate measurements of LAA dimension in order to select the correct device sizes.

Michael D. Lesh - One of the best experts on this subject based on the ideXlab platform.

  • cristal tachycardias origin of right atrial tachycardias from the crista terminalis identified by Intracardiac Echocardiography
    Journal of the American College of Cardiology, 1998
    Co-Authors: Jonathan M. Kalman, Jeffrey E. Olgin, Martin R. Karch, Mohamed H Hamdan, Michael D. Lesh
    Abstract:

    Abstract Objectives. We sought to use Intracardiac Echocardiography (ICE) to identify the anatomic origin of focal right atrial tachycardias and to define their relation with the crista terminalis (CT). Background. Previous studies using ICE during mapping of atrial flutter and inappropriate sinus tachycardia have demonstrated an important relation between endocardial anatomy and electrophysiologic events. Recent studies have suggested that right atrial tachycardias may also have a characteristic anatomic distribution. Methods. Twenty-three consecutive patients with 27 right atrial tachycardias were included in the study. ICE was used to facilitate activation mapping in relation to endocardial structures. A 20-pole catheter was positioned along the CT under ICE guidance. ICE was also used to assist in guiding detailed mapping with the ablation catheter in the right atrium. Results. Of 27 focal right atrial tachycardias, 18 (67%, 95% confidence interval [CI] 46% to 83%) were on the CT (2 high medial, 8 high lateral, 6 mid and 2 low). ICE identified the location of the tip of the ablation catheter in immediate relation to the CT in all 18 cases. The 20-pole mapping catheter together with echocardiographic visualization of the CT provided a guide to the site of tachycardia origin along this structure. Radiofrequency ablation was successful in 26 (96%) of 27 (95% CI 81% to 100%) right atrial tachycardias. Conclusions. This study demonstrates that approximately two thirds of focal right atrial tachycardias occurring in the absence of structural heart disease will arise along the CT. Recognition of this common distribution may potentially facilitate mapping and ablation of these tachycardias.

  • use of Intracardiac Echocardiography in interventional electrophysiology
    Pacing and Clinical Electrophysiology, 1997
    Co-Authors: Jonathan M Kalman, Jeffrey E. Olgin, Martin R. Karch, Michael D. Lesh
    Abstract:

    Intracardiac Echocardiography is emerging as a potentially useful tool during RF ablation procedures. There are a number of potential benefits of direct endocardial visualization during RF ablation including: (1) precise anatomical localization of the ablation catheter tip in relation to important endocardial structures, which cannot be visualized with fluoroscopy; (2) reduction in fluoroscopy time; (3) evaluation of catheter tip tissue contact; (4) confirmation of lesion formation and identification of lesion size and continuity; (5) immediate identification of complications; and (6) as a research tool to help in understanding the critical role played by specific endocardial structures in arrhythmogenesis. This article will review existing data and speculate as to possible future roles for Intracardiac Echocardiography in interventional electrophysiology.

  • biophysical characteristics of radiofrequency lesion formation in vivo dynamics of catheter tip tissue contact evaluated by Intracardiac Echocardiography
    American Heart Journal, 1997
    Co-Authors: Jonathan M Kalman, Jeffrey E. Olgin, Michael C. Chin, Melvin M. Scheinman, Adam P. Fitzpatrick, Michael D. Lesh
    Abstract:

    Abstract During clinical radiofrequency catheter ablation a wide range of delivered power may be necessary to achieve success despite an apparently stable catheter position on fluoroscopy. The purpose of this study was to use Intracardiac Echocardiography to characterize the relation between catheter tip–tissue contact and the efficiency of heating during applications of radiofrequency energy in vivo and to determine whether Intracardiac Echocardiography could be used prospectively to improve tissue contact. A closed-loop temperature feedback control system was used during radiofrequency applications at five anatomic regions in the right atrium of 15 anesthetized dogs to ensure achievement of a predetermined temperature (70° C) at the catheter tip thermistor by automatic adjustment of delivered power (maximum 100 W). The efficiency-of-heating index was defined as the ratio of steady-state temperature (degrees Celsius) to power (watts). Two-dimensional Intracardiac Echocardiography was used to evaluate movement of the catheter tip relative to the endocardium. Perpendicular contact was scored as good, average, or poor and lateral catheter sliding as 5 mm. Two groups of animals were included: group 1, in which tissue contact was guided by fluoroscopic and electrographic criteria for stability of contact, with Intracardiac Echocardiography used simply to observe the application; and group 2, in which tissue contact was guided by Intracardiac Echocardiography. Of 66 applications, 18 (27.3%) had poor perpendicular contact on Echocardiography, and 12 (18.2%) demonstrated lateral sliding of >5 mm even though they had been considered to have good tissue contact by fluoroscopic and electrographic criteria. Perpendicular catheter contact and anatomic location were shown to be independently related to the efficiency-of-heating index. Applications with good perpendicular contact had a significantly higher efficiency-of-heating index and a significantly greater lesion size than those with average or poor contact. The percentage of applications having good perpendicular tissue contact and the lesion size were significantly greater when tissue contact was guided by Intracardiac Echocardiography compared with fluoroscopic and electrographic guidance. This study demonstrates that variations in catheter tip–tissue contact account for differences in the efficiency of tissue heating, independently of the anatomic site of the application. Poor tissue contact was observed by Intracardiac Echocardiography and confirmed by indexes of tissue heating in approximately one third of radiofrequency applications despite a fluoroscopic appearance and electrographic morphologic appearance suggestive of good tissue contact. There was a significant correlation between echocardiographic evaluation of tissue contact, parameters of tissue heating (efficiency-of-heating index), and lesion size. In addition, Intracardiac Echocardiography could be used prospectively to improve the percentage of good contact applications and increase the lesion size. (Am Heart J 1997;133:8-18.)

  • radiofrequency catheter modification of sinus pacemaker function guided by Intracardiac Echocardiography
    Circulation, 1995
    Co-Authors: Jonathan M Kalman, Michael C. Chin, Michael D. Lesh, Randall J Lee, Westby G Fisher, Phillip Ursell, Carol Stillson, Melvin M. Scheinman
    Abstract:

    Background The sinus P wave arises from a pacemaker complex distributed along the crista terminalis. We investigated the feasibility of modification of sinus pacemaker function using graded applications of radiofrequency energy along the crista terminalis in dogs to achieve sinus rate control. Methods and Results Modification of sinus pacemaker function (30±5% reduction in intrinsic heart rate with retention of a normal P-wave axis) was performed in 11 dogs (group 1). Total sinus pacemaker ablation (>50% reduction in intrinsic heart rate with development of a low ectopic atrial or a junctional rhythm) was performed in 4 dogs (group 2). Intracardiac Echocardiography was used to identify the crista terminalis as an anatomic marker of sinus node location. Sinus pacemaker modification caused a significant decrease in intrinsic heart rate (31% reduction, P<.001), heart rate responsiveness to isoproterenol (30% reduction, P<.0001), and average (20% reduction, P=.0002) and maximal (22% reduction, P=.0007) heart ...

  • Intracardiac Echocardiography during radiofrequency catheter ablation of cardiac arrhythmias in humans
    Journal of the American College of Cardiology, 1994
    Co-Authors: Jonathan M Kalman, Michael Kwasman, Nelson B. Schiller, Laurence M. Epstein, Peter J. Fitzgerald, Paul G. Yock, Michael D. Lesh
    Abstract:

    OBJECTIVES: The purpose of this study was to describe our preliminary experience using catheter-based Intracardiac Echocardiography as an adjunct to biplane fluoroscopy for guiding radiofrequency catheter ablation of atrial arrhythmias in the right side of the heart. BACKGROUND: Catheter ablation requires precise positioning and stable ablation electrode-endocardial contact. This procedure is currently guided by an analysis of Intracardiac electrograms and fluoroscopy. However, the use of fluoroscopy does not allow the endocardium and certain anatomic landmarks to be identified and is associated with the hazards of radiation exposure. METHODS: Seventeen symptomatic patients were studied. A 10F 10-MHz Intracardiac imaging catheter was used to visualize specific anatomic landmarks in the right atrium for directing the ablation electrode in 15 patients undergoing radiofrequency ablation of 19 arrhythmias and to assist with interatrial septal puncture in 3 patients. RESULTS: Continuous Intracardiac imaging was performed for a mean +/- SD of 63.6 +/- 39.2 min and demonstrated distal electrode-endocardial tissue contact in 81 (60%) of 134 radiofrequency applications. Movement of the catheter was demonstrated during 36 (44%), microcavitations during 39 (48%) and thrombus during 15 (19%) of the 81 imaged applications. In 7 of 10 procedures for atrial flutter, successful ablation was directed at anatomic corridors in the right atrium visualized with Intracardiac Echocardiography. During ablation of atrial tachycardia, imaging identified abnormal atrial anatomy related to previous surgery and guided successful ablation of a reentrant tachycardia circulating around these anatomic obstacles. In two procedures for slow pathway modification of atrioventricular node reentrant tachycardia, Intracardiac Echocardiography confirmed catheter stability at the tricuspid annulus anterior to the coronary sinus. CONCLUSIONS: During catheter ablation, Intracardiac Echocardiography augments fluoroscopy by visualizing anatomic landmarks, ensuring stable endocardial contact and assisting in transseptal puncture. Ablation of typical atrial flutter can be successfully directed at anatomic corridors identified using Intracardiac imaging.

Thomas Bartel - One of the best experts on this subject based on the ideXlab platform.

  • Intracardiac Echocardiography for guidance of transcatheter aortic valve implantation under monitored sedation a solution to a dilemma
    European Journal of Echocardiography, 2015
    Co-Authors: Thomas Bartel, Corinna Veliksalchner, Ahmad Edris, Silvana Muller
    Abstract:

    Transcatheter aortic valve implantation (TAVI) has been established as a valuable alternative to surgical aortic valve replacement in patients deemed to have high or prohibitive perioperative risk. However, there are several technical constraints and procedural risks inherent to TAVI. These risks include annulus rupture, ventricular perforation, aortic dissection, coronary occlusion, and dislodgement or migration of the valve prosthesis to the aorta or the left ventricle (LV). Other complications may be related to inappropriate valve deployment and subsequent paravalvular leak. Most complications cannot be detected at an early stage without echocardiographic guidance. Although not addressed by current guidelines, some European centres have advocated a ‘minimalist’ approach with exclusively fluoroscopic and angiographic guidance. Transoesophageal Echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging, has been established as a standard approach for peri-interventional guidance of TAVI. However, TEE monitoring almost always necessitates general anaesthesia and endotracheal intubation. A potential alternative to TEE is Intracardiac Echocardiography (ICE) that may provide a solution to a common dilemma: the most important advantage of ICE being the compatibility with monitored anaesthesia care without endotracheal intubation. Other advantages of ICE include uninterrupted monitoring, no fluoroscopic interference, and precise Doppler-based assessment of pulmonary artery pressures. Limitations of ICE include the need for additional venous access, the learning curve associated with a new device, and potentially increased cost.

  • why is Intracardiac Echocardiography helpful benefits costs and how to learn
    European Heart Journal, 2014
    Co-Authors: Thomas Bartel, Silvana Muller, Angelo B Biviano, Rebecca T Hahn
    Abstract:

    Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. Intracardiac Echocardiography (ICE) complements and has in part replaced transoesophageal Echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging. The latter is still widely accepted as a method to prepare for and to guide interventional treatments. In contrast to TEE, ICE represents a purely intraprocedural guiding and imaging tool unsuitable for diagnostic purposes. Patients tolerate ICE much better, and the method does not require general anaesthesia. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications. This review describes the peri-interventional role of ICE, outlines current limitations, and points out future implications. Two-dimensional ICE has become a suitable guiding tool for a variety of percutaneous treatments in patients who are conscious or under monitored anaesthesia care, whereas RT-3DICE is still undergoing clinical testing. Continuous TEE monitoring under general anaesthesia remains a widely accepted alternative.

  • why is Intracardiac Echocardiography helpful benefits costs and how to learn
    European Heart Journal, 2014
    Co-Authors: Thomas Bartel, Silvana Muller, Angelo B Biviano, Rebecca T Hahn
    Abstract:

    Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. Intracardiac Echocardiography (ICE) complements and has in part replaced transoesophageal Echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging. The latter is still widely accepted as a method to prepare for and to guide interventional treatments. In contrast to TEE, ICE represents a purely intraprocedural guiding and imaging tool unsuitable for diagnostic purposes. Patients tolerate ICE much better, and the method does not require general anaesthesia. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications. This review describes the peri-interventional role of ICE, outlines current limitations, and points out future implications. Two-dimensional ICE has become a suitable guiding tool for a variety of percutaneous treatments in patients who are conscious or under monitored anaesthesia care, whereas RT-3DICE is still undergoing clinical testing. Continuous TEE monitoring under general anaesthesia remains a widely accepted alternative.

  • Intracardiac Echocardiography a new guiding tool for transcatheter aortic valve replacement
    Journal of The American Society of Echocardiography, 2011
    Co-Authors: Thomas Bartel, Nikolaos Bonaros, Ludwig Muller, Guy Friedrich, Michael Grimm, Corinna Veliksalchner, Gudrun Feuchtner, Florian Pedross, Silvana Muller
    Abstract:

    Background Echocardiography has been debated as an adjunct for transcatheter aortic valve replacement (TAVR). The aim of this prospective study was to comparatively evaluate intraprocedural guidance using Intracardiac Echocardiography (ICE) and transesophageal Echocardiography (TEE). Methods Fifty high-risk patients with severe aortic stenosis scheduled for TAVR were randomized to either guidance using ICE (group 1; n  = 25) or monitoring using TEE (group 2; n  = 25). Results In contrast to TEE, ICE allowed continuous monitoring. The need for probe repositioning during the procedure was much lower in group 1 (0.1 ± 0.3 vs 5.7 ± 0.7 maneuvers, P P  = .003). Both coronary ostia were more frequently visualized in group 1 (18 vs 2 cases, P n  = 25, r 2  = 0.90, P n  = 11, P  = .012), but ICE did not (mean difference, −0.3 ± 14.1 mm Hg; n  = 25, P  = .913). ICE and TEE detected newly grown thrombi (2 vs 1 case). Severe complications (e.g., annular dissection, pericardial effusion) were not observed. Conclusions ICE, which is compatible with sedation and local anesthesia, can be considered an alternative to TEE for intraprocedural guidance during TAVR. It also seems to match the required work flow during TAVR better than TEE.

  • Intracardiac Echocardiography an ideal guiding tool for device closure of interatrial communications
    European Journal of Echocardiography, 2005
    Co-Authors: Thomas Bartel, Thomas Konorza, Holger Eggebrecht, Ulrich Neudorf, Tiko Ebralize, Achim Gutersohn, Raimund Erbel
    Abstract:

    Background This study sought to evaluate safety and radiation exposure when using Intracardiac Echocardiography (ICE) in comparison to transesophageal Echocardiography (TEE) in order to guide transcatheter closure of interatrial communications. Methods Eighty patients (44 males, 36 females, mean age 46, SD 13 years) undergoing device closure of atrial septal defect ( n =12) or patent foramen ovale ( n =68) had the procedure guided by ICE ( n =50, group 1) or TEE ( n =30, group 2). In group 1, all procedural stages were completely guided by ICE, including imaging of the interatrial communication during balloon sizing, device unfolding and release, and during the final check for adequate positioning. In group 2, exclusive implantation of devices was guided by use of TEE. Results Especially, the spatial relationship between device and cardiac structures (e.g. the ascending aorta, the interatrial septum and the superior vena cava) was accurately demonstrated in group 1. Image resolution provided by ICE was superior to that of TEE. No severe complications, including any related to ICE, were seen. Fluoroscopy time (FT) and procedure time (PT) were shorter in group 1 than in group 2 (FT: 5.5±1.5min vs. 9.3±1.6min, P <0.0001; PT: 31.9±4.6min vs. 38.8±5.8min, P <0.01). Neither sedation nor anesthesia was required in group 1. Conclusions ICE is a safe tool to guide device closure of interatrial communications. For the patient, procedural stress and radiation exposure are negligible. ICE can be considered the guiding tool of choice for device closure, particularly when long or repeated echocardiographic viewing is required.

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