Intracardiac Echocardiogram Research Articles

Experience with the Hansen Robotic System for Atrial Fibrillation Ablation—Lessons Learned and Techniques Modified: Hansen in the Real World

The Hansen robotic system has only recently been used in the United States for catheter ablation procedures in humans. Atrial fibrillation (AF) ablation may be performed utilizing this system. We report our management of complications with early experience of this system. All 71 patients in whom the system was utilized were included. In all patients, a 2-operator technique was to be employed; one operator manipulates the ablation catheter via the robot and the other manipulates the circular mapping and intracardiac echocardiogram catheters. There was no procedure-related mortality. All vascular complications occurred in the first 25 procedures performed. There were 6 intraoperative procedural-related complications. These included significant vascular complications (n = 4), one of whom required iliac vein stenting, and 2 cardiac tamponade (one related to a pop-phenomenon)-successfully treated by pericardiocentesis. Early complications (n = 3) were 1 tamponade several hours post-procedure, 1 vascular complication, and 1 pericarditis. Late complications included 5 patients with severe pulmonary vein stenosis (all in first 27 patients) and 1 patient with gastroparesis. All complications were successfully managed without persistent morbidity and occurred earlier in our experience. This led to specific alterations in our vascular access and ablation techniques. These include the use of a longer 14 Fr sheath, through which the robotic sheath is more safely advanced. The choice of ablation catheter and titration of power, particularly when the catheter has a perpendicular orientation to the atrial wall, is also important. The suggested modifications may make the system easier to use with the potential to reduce complications.

Cardiac calcified amorphous tumor in a patient presenting for ventricular tachycardia ablation: intracardiac echocardiogram diagnosis and management

Calcified amorphous tumors (CAT) of the heart are rare primary cardiac tumors characterized by heavy myocardial and valve apparatus calcification. The relationship of the entity with ventricular arrhythmia, if any, is unknown. We describe a case of cardiac CAT in a 58-year-old woman with prior cardiac arrest and recurrent ventricular tachycardia who presented for radiofrequency ablation. Pre-ablation intracardiac echocardiogram revealed the characteristic endomyocardial calcific pattern associated with this tumor that precluded catheter manipulation in the left ventricle. The imaging characteristics and management are described.

Abstract 4865: The Amplitude Ratio of the First to Second Heart Sound Mirrors Left Ventricular Systolic Function

Background: In animal studies, the amplitude of the mitral component of the first heart sound (S1) is proportional to the rate of left ventricular pressure rise (dP/dt). To develop a clinical application for this property, we tested the hypothesis that the relative amplitudes of S1 and S2 (aortic component of second heart sound) represent left ventricular dP/dt and ejection fraction (EF) in humans. Methods: Phono-electrocardiographic recordings using a digital hand-held device (HD Medical Group Ltd) followed by an echocardiogram were performed within two hours of a clinically indicated cardiac catheterization. Left ventricular dP/dt was estimated by intracardiac manometer or Doppler echocardiogram, left ventricular EF was measured by biplane 2D. The largest positive to negative deflections of the first and second heart sound components were defined as S1 and S2. The ratios of S1 to S2 (S1/S2) were obtained from the right upper sternal border (RUSB), left upper sternal border (LUSB) and apical area. Normal EF and dP/dt were defined as ≥ 55% and ≥ 1000 mmHg/s respectively. Results: We studied 61 patients with dP/dt ranging from 400 to 2850 mmHg/sec, EF ranging from 11 to 78 %. Body mass index, P-R interval, pulmonary or systemic blood pressure were not different between the normal and reduced EF or dP/dt groups. Compared with the group with reduced dP/dt or EF, the median S1/S2 at LUSB and RUSB were significantly higher in those with normal dP/dt (1.52 vs 0.78 for LUSB; 1.31 vs 0.75 for RUSB, p<0.05) or EF (1.44 vs 0.95 for LUSB; 1.65 vs 0.83 for RUBS, p<0.05). On receiver operating curve analysis, S1/S2 at LUSB and RUSB, had significant discriminative values for detecting normal dP/dt (AUC = 0.82 for LUSB, 0.74 for RUSB) and EF (AUC = 0.72 for LUSB, 0.68 for RUSB). The sensitivity and specificity of S1/S2 ≥1 for detecting normal left ventricular systolic function (normal dP/dt or EF) were 72– 80% and 57–71% respectively. Conclusion: This study demonstrated that S1, corrected for S2, mirrors left ventricular systolic function. A ratio of S1 to S2 of ≥1 is a useful indicator of normal left ventricular systolic function defined by dP/dt ≥1000 mmHg/s or EF ≥55%. Digital phonocardiography appears promising as an adjunctive bed-side tool for assessing left ventricular systolic function.

Importância da ecocardiografia intra-operatória em tempo real como guia para o tratamento percutâneo dos defeitos septais por meio do dispositivo de Amplatzer

interatrial communication and echocardiographic criteria for percutaneous treatment of septal defect.The interatrial communication occlusion procedure must be continually monitored by transesophageal or intracardiac echocardiogram, since invaluable detailed information is provided, such as: stretched diameter measure – crucial for the choice on prosthesis size to be used; left atrium disk location guidance – thus avoiding dislocation through the defect; device positioning after all components have been opened; and tracking of possible periprosthetic residual flow (Figure 1).

Novel Applications in Catheter Ablation

Catheter based treatment of arrhythmia has gained significant attention during the last two decades. Due to the explosive development in ablation treatment of atrial fibrillation, huge interest in new tools was born to help in the atrial fibrillation ablation procedures. The aim of this review is to describe the role of these novel techniques and tools aimed at improving the implementation of catheter based ablations of atrial arrhythmias by focusing on the use of intra-cardiac echocardiogram and robotic navigation.