THE FIRST EXPERIENCE OF ULTRASOUND MAPPING FOR ABLATION OF ATRIAL FIBRILLATION IN RUSSIA

To report the first experience of application of the CartoSound technique in Russia for three-dimensional mapping in the real time mode during radiofrequency ablation (RFA) of atrial fibrillation (AF), six patients with paroxysmal (n=2) and persistent (n=4) AF were examined and operated on. All study subjects were younger than 70 years (aged 58±3.8 years) and were free of structural heart pathology. Mean class of arrhythmic symptoms by EHRA was 3.6±0.2. In one patient, antral isolation of pulmonary vein ostia was performed twice. The anterio-posterior left atrium (LA) size was 4.8±0.5 cm, the left ventricle ejection fraction by Simpson, 49±4%. During the procedure, the following catheters have been introduced: 10 polar diagnostic electrode into the coronary sinus, ultrasound catheter into the right atrium, and ablation catheter into the left atrium. All ultrasound images were synchronized with the R-wave of surface ECG; three-dimensional maps of the LA, pulmonary veins, and esophagus were generated. Ultrasound mapping was accompanied by fast electroanatomic mapping (FAM) of LA and pulmonary veins. After three-dimensional mapping of the LA, pulmonary veins, and esophagus, antral pulmonary vein isolation was performed with the power of 30 40 W, temperature of 40 45°C, and irrigation velocity of 17 ml/min. The time necessary for development of maps of the LA, pulmonary veins, and esophagus, decreased from the first patient to the sixth one from 23.5 min to 16 min and the overall duration of the procedure, from 167 min to 138 min. According to the 24 hour Holter ECG monitoring data performed on the 3-4 days after the procedure, the sinus rhythm was documented in 5 patients of 6. Thus, three-dimensional ultrasound mapping of LA, pulmonary veins, and esophagus is a reliable method of visualization control during antral pulmonary vein isolation. Intracardiac echocardiography is not associated with any radiological (X--ray) exposure, does not require administration of the contrast medium, and is, per se, the only method of “monitoring of anatomy” in the real time mode. It seems to be a safe and effective alternative to tomographic techniques; however, no relevant data of randomized studies are currently available. In the nearest future, the technique seems to be applied increasingly, taking a continuous rise in the number of radiofrequency ablations due to AF into the account. Thus, three-dimensional ultrasound mapping is a reliable visualizing method for antral pulmonary vein isolation.

atrial fibrillation, left atrium, antral pulmonary vein isolation, three-dimensional mapping, intracardiac echocardiography

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