Advantages of the integration of ICE and 3D electroanatomical mapping and ultrasound-guided femoral venipuncture in catheter ablation of atrial fibrillation

Purpose To evaluate how the integration of intracardiac echocardiography (ICE) and ultrasound-guided femoral venipuncture (USGVC) may affect the safety of catheter ablation (CA) of atrial fibrillation (AF). Methods From a single center 374 patients with AF underwent 3D electroanatomic mapping-guided CA with or without the integration of ICE and USGVC. The primary endpoints were periprocedural complications, fluoroscopy time, and procedure time between the two groups. Results The median age of patients was 60 years. Sixteen patients had major complications (4.3%); 10 of these (2.7%) had major vascular complications. Thirty-seven patients had minor complications (9.9%) that did not require intervention. There were fewer major complications in the CA with the aid of ICE and USGVC than in the conventional approach (1% vs 7%,p = 0.004). The combined approach required less fluoroscopy time than the conventional procedure (median with ICE + USGVC 14 min (interquartile range (IQR) 8-21) vs median without ICE + USGVC 22 min (IQR 17-32)),p < 0.001, and less radiofrequency time (median with ICE + USGVC 1686 s (IQR 1367-1998) vs median time without ICE + USGVC: 1792 s (IQR 1390-2400)),p = 0.012. After adjustment for confounding factors, only the use of ICE + USGVC (hazard ratio: 0.139;p = 0.05) was a significantly protective factor against major complications. Conclusion The use of ICE and USGVC in CA of AF is associated with significantly fewer major complications and lower fluoroscopy and radiofrequency time, so these aids increased the safety of the procedure.