Intracardiac Echocardiography Improves Procedural Efficiency During Cryoballoon Ablation for Atrial Fibrillation: A Pilot Study

Intracardiac Echocardiography Guided Cryoballoon Ablation. Background: Cryoballoon ablation is increasingly used for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). This new technique aims to perform PVI safer and faster. However, procedure and fluoroscopy times were similar to conventional RF approaches. We compared ICE plus fluoroscopy versus fluoroscopy alone for anatomical guidance of PVI. Methods: Forty‐three consecutive patients with paroxysmal AF were randomly assigned to ICE plus fluoroscopy (n = 22) versus fluoroscopy alone (n = 21) for guidance of cryoballoon PVI. A “single big balloon” procedure using a 28 mm cryoballoon was performed. The optimal ICE‐guided position of the cryoballoon was assessed by full ostial occlusion and loss of Doppler coded reflow to the left atrium (LA). Any further freezes were ICE‐guided only without use of fluoroscopy or contrast media injection. Results: A total of 171 pulmonary veins could be visualized with ICE. 80% of ICE‐guided freezes were performed with excellent ICE quality. Acute procedural success and AF recurrence rate at 6 months were similar in both groups (AF recurrence: ICE‐guided = 27% vs Fluoroscopy = 33%; P = ns). Patients without ICE guidance had significantly longer procedure (143 ± 27 minutes vs 130 ± 19 minutes; P = 0.05) and fluoroscopy times (42 ± 13 minutes vs 26 ± 10, P = 0.01). The total amount of contrast used during the procedure was significantly lower in patients with ICE guidance (88 ± 31 mL vs 169 ± 38 mL, P < 0.001). Conclusion: Additional ICE guidance appears to be associated with lower fluoroscopy, contrast, and procedure times, with similar efficacy rates. Specifically, ICE allows for better identification of the PV LA junction and more precise anatomically guided cryoballoon ablations. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1202‐1207, November 2010)