The Use Of Intracardiac Echocardiography And Method To Guide Noncoronary Cardiac Interventions

Objective:we sought to assess the utilization and strategy of intracardiac echocardiography (ICE) during noncoronary Cardiac Interventions, evaluated the feasibility and accuracy guided with and without the help of ICE.Methods:A consecutive series of 46 patients were selected from the cardiology department of the first affiliated hospital in Kunming Medical College, who were capable of being underwent transcatheter closure of interatrial communications, ablations of supraventricular tachycardia and implantions of pacemakers through jugular with (group1:23patients,12men,11women,45.78±21.54 years)and without (group2:23patients,12men,11women,49.22±24.79years) the guidance of ICE respectively between July,2010and April,2011 in our cardiac interventional center. There were 7 vs 7 ASD patients underwent transcatheter closure;6 vs 6 AVRT by left pathway,2 vs 2 PSAF,and 1 vs 1 AVNRT underwent ablations;3 vs 3 SSS,4 vs 3 AVB,0 vs 1 syncope underwent implantions of pacemakers in group 1 and group 2 respectively. We measured the fluoroscopy time and the total procedure time, compared the difficulty of the procedure, locations of the ablation catheters and the complications between the two groups, assessed the feasibility, safety and metho-dology of using ICE for the guidance of noncoronary cardiac interventions. A level of statistical significance was set to P value<0.05.Results:(1)All the 23 patients with the ICE guidance in group land the another 23 without ICE were completed the whole procedure,none of the sever complements or damage to cardiac structure, such as perforation, thrombus formation was found in all the cases. The complement rate was higher as 100%, the death rate was lower down to 0%. (2)During the procedure for closure of ASD, the diameter measured with ICE and TEE were correlated with each other (R=-0.44, P<0.05), the model of the regression:ICE=-0.359TEE+26.72mm, it suggested the negative relation between them,the diameter measured by TEE was overestimated than by ICE. The diameter measured with ICE and TEE were both significantly correlated with those occludes (R=0.942,P<0.05; and R=0.928, P<0.01), the model of the diameter: ASD=0.91ICE+5.64mm,P<0.01;and ASD=0.892TEE+6.03mm,P<0.01,respectively, it suggested the diameter measured by ICE was more correlative with the occludes than by TEE, and it was more accuracy.The predict diameter of ASD with ICE was trended to be higher 2～4mm than the measurement.(3)During the procedure for ablations, ICE could image the movement and position of the sheaths and catheters, guide the transseptal puncture, monitor the damage to adjacent structure, improve the whole procedure. Our study showed the tip of the catheter was in an appropriate position under the fluoroscopy in 2 cases, though it deviated from the target location with the imaging of ICE, titrated the radiofrequency by adjusting the catheter eventually. (4) During the procedure for implantations, ICE could provide the image visualization for the movement of the cathodes, embedment of screw-in electrodes. we noticed the screw-in cathode stretch out and spin into the heart tissue of the right outflow of the right ventricle.(5)The total fluoroscopy time in patients guided with ICE underwent the procedure were shorter than those guided with TEE:13.87±5.63min versus 25.09±10.32min, (P<0.001); On the contrary, the mean procedure time were longer than that of controls:87.61±23.25min versus 49.30±12.6min (p<0.001). The patients guided with ICE feeled no uncomfortable, suffered no serious complications during and after the procedure in 24 hours.Conclusion:(1) The procedure for closure of ASD guided with ICE was superior to those with TEE. ICE could improve the image for the diameter, modality and location of ASD, visualization for the adjacent to the surroundings under the X-rays, facilitate the monitoring for the placement of the occlude devices, assess the quality and quantity of the residual shunt by Doppler, detect and prevent the complications earlier. We suggest to chose the diameter of the device 2～4mm larger than the measurement with ICE. ICE was an alternative choice to fulfillment for transseptal close for ASD. (2) During the procedure for ablations guided with ICE, the cardiac structure, movement for catheter, transseptal puncture, contact to the subtrate, delivery of the radiofrequency, linear lesion were monitored by the image of ICE, thus improved the procedure and safety. (3) During the procedure for implantations of the screw-in helix cathodes with ICE,it facilitated the image of the right outflow of the right ventrile, hemodynamics, target position, movement of the cathode,contact to the surface of the outflow and so on, detect the deviation and complications. (4) Though the procedure time guided with ICE was longer than that without ICE, it would not cause the patient to feel nervous, anxiety ,and fearable; increase the complications such as hematoma, damage to vascular, pericardial tamponade and death rate, on the contrary it could detect and prevent severe complications, reduce the exposure of the fluoroscopy to patients and operators, hence improve the safety. (5) The use of ICE might be efficient,safe and repetitive. The key step of steering the ICE catheter might be the location and orientation inside the spatial capacity of the left heart under the X-rays and the image of ICE itself after percutaneous approach, dilatation, delivery, positioning inside the right atrium.