Use of intracardiac echocardiography in Latin America: a case series

Abstract

Abstract Funding Acknowledgements: Type of funding sources: None. The use of Intracardiac Echocardiography (ICE) for cardiac arrhythmia ablations has been associated with reductions in fluoroscopy dose and procedure time, while enabling operators to locate the ablation catheters more accurately in the setting of complex arrhythmias. The added cost of ICE per procedure is a significant barrier for its implementation in developing countries. Reprocessing ICE catheters could be the alternative that allows electrophysiologist working with limited resources to implement this state of the art tool. Electrophysiology procedures using ICE in a private practice in the Dominican Republic that reprocess ICE catheters were retrospectively evaluated. Complications and reported compromise of the structural integrity or the quality of the images were recorded. The total cost of the catheters was distributed among the amount of cases where they were used to determine cost-per-use of each catheter. In the evaluated period, 2 catheters were used for 26 procedures, submitting each catheter to 12 reprocessing cycles. There was no reported compromise of the structural integrity of the catheter or the quality of the image. The only complication reported was 2 pericardial effusion after an ablation of atrial fibrillation plus atrial flutter; notwithstanding, the events were not related to the performance of the ICE. Distributing the cost of each catheter among a total of 13 uses per catheter, the total cost per use of ICE catheter was US$265.38. Reprocessing of ICE catheters was safe and effective in the series of patients evaluated. The complications reported were not attributed to the performance of the ICE catheter. A significant reduction of the cost of the catheter from original amount implies a potential increase in the use of this technology in the Dominican Republic, without compromise on the benefits. This could also serve as a model for the implementation of ICE in other developing countries of the region.