Safety And Efficacy Of Catheter Ablation Of Ventricular Arhythmias Assisted By Intracardiac Echocardiography

Background:Ventricular arrhythmia is a common type of arrhythmia,and catheter ablation is an effective means of treatment.With the advantage of providing high-quality cardiac imaging in real time,intracardiac echocardiography has been widely used in cardiac interventional diagnosis and treatment.However,there are still few reports on the efficacy and safety of intracardiac echocardiography-assisted catheter ablation in the treatment of ventricular arrhythmias.The aim of this study was to compare the safety and efficacy of catheter ablation with or without intracardiac echocardiography in patients with ventricular arrhythmias,and to analyze the subgroups according to the origin of ventricular arrhythmia,in order to improve the clinical understanding of intracardiac echocardiography in the ablation of ventricular arrhythmias.Methods:This research is a single-center retrospective study.The baseline data and surgical information of patients who received catheter ablation of premature ventricular complexes or ventricular tachycardia from May 1,2019 to July 31,2022 were collected and divided into ICE group and control group according to whether intraoperative intracardiac echocardiography was used or not.The follow-up of the patients ended on December 1,2022,and the end points included recurrence of ventricular arrhythmias,readmission of cardiovascular diseases,and death.The differences of acute success rate,long-term success rate and perioperative complications between the two groups were compared,and further subgroup analysis was made according to the origin site.In addition,Logistic regression analysis and Cox regression analysis were used to explore the predictive factors of acute failure and recurrence of catheter ablation of ventricular arrhythmias.Results:A total of 606 patients were enrolled in this study,including 155 patients in the ICE group and 451 patients in the control group.The average age of the included cases was 46.33±15.86 years,42.1%were male,and the average course of disease was 12 months.There were fewer patients with RVOT origin in the ICE group(41.9%vs 59.6%,P<0.001).A total of 13 patients lost follow-up,including 6 patients in control group and 7 patients in ICE group.There was a significant difference in the incidence of complications between the two groups.The incidence of perioperative complications in the ICE group was lower than that in the control group(9.7%vs 16.9%,P=0.031).In addition,the operation time of the ICE group was longer(115.65±51.04min vs 103.95±47.22min,P=0.009),while the intraoperative fluoroscopy time was shorter(83.84±70.43s vs 129.13±85.79s,P<0.001),the radiation exposure dose was lower(7.90±6.73mGy vs 12.15±8.21 mGy,P<0.001),and the postoperative hospital stay was less than that of the control group(1.56±0.95d vs 1.99±2.35d,P=0.027).There was no significant difference in acute success rate between the two groups.Kaplan-Meier curve also showed that there was no significant difference in long-term success rate between the ICE group and the control group(Log-rank test,P=0.142).According to the subgroup analysis of the origin site,there was no significant difference in the acute and long-term success rate of catheter ablation of ventricular arrhythmias between the ICE group and the control group.The number of ablation sites and ablation time were analyzed according to the origin site.In the left ventricular summit or epicardial origin subgroup,the number of ablation sites and ablation time in the ICE group were lower than those in the control group(2.75±1.41 vs 1.83±0.86,P=0.034;247.56±131.77s vs 185.18±80.38s,P=0.022).Through Logistic regression analysis and Cox regression analysis,it was found that operation time was an independent predictor of acute catheter ablation failure and postoperative recurrence.Multivariate Logistic regression analysis showed that operation time was a risk factor for acute surgical failure(OR=1.018,95%CI(1.012-1.025),P<0.001).Multivariate Cox regression analysis showed that operation time was also an independent predictor of ventricular arrhythmia recurrence(HR=1.008,95%CI(1.001-1.014),P=0.020).Conclusions:1、In this study,we found that the application of intracardiac echocardiography in catheter ablation of ventricular arrhythmias was associated with lower incidence of complications,shorter fluoroscopy time,less contrast agent exposure and shorter postoperative hospital stay compared with the control group.2、For patients with left ventricular summit or epicardial origin,the application of intracardiac echocardiography can improve their clinical benefits.3、The acute and long-term success rates of catheter ablation of ventricular arrhythmias assisted by intracardiac echocardiography were similar to those in the control group.4、The longer the operation time,the higher the risk of worse clinical outcome,and the operation time is an independent risk factor for acute and long-term outcome of catheter ablation of ventricular arrhythmias.