Preclinical Experience Using 4D Intracardiac Echocardiography to Guide Cardiac Electrophysiology Procedures

Area of Science:

• Cardiovascular Imaging
• Electrophysiology
• Medical Device Technology

Background:

• Intracardiac echocardiography (ICE) is crucial for electrophysiology (EP) procedures, aiding real-time monitoring and catheter navigation.
• Four-dimensional (4D) ICE enhances traditional ICE with 360° rotation, multiplanar imaging, and volumetric acquisition capabilities.
• A novel 4D ICE catheter (NuVision, Biosense Webster) was evaluated in a preclinical swine model for structural EP and ventricular ablations.

Purpose of the Study:

• To assess the utility of a novel 4D ICE catheter in a preclinical setting.
• To evaluate 4D ICE for creating anatomical shells, guiding ablations, and simulating left atrial appendage occlusion (LAAO) procedures.

Main Methods:

• Seven swine underwent procedures using the 4D ICE catheter integrated with the CARTO mapping system.
• Anatomical shells of the right ventricle (RV), left ventricle (LV), and left atrium (LA) were created.
• Ablations were performed on the RV moderator band and LV papillary muscles; LAA imaging was done to simulate LAAO.

Main Results:

• CARTOSOUND reconstruction using the 4D ICE platform enabled efficient anatomical shell creation with minimal catheter movement.
• Ablation lesions were accurately delivered to target sites (RV moderator band, LV papillary muscles) with good correlation to pathology.
• Multiplanar and 3D volumetric images of the LAA were acquired, simulating LAAO device placement.

Conclusions:

• 4D ICE represents a significant advancement in EP imaging, offering TEE-like capabilities within the heart.
• The novel 4D ICE catheter facilitated efficient anatomical mapping and precise ablation guidance in complex intracardiac structures.
• This technology shows potential as an alternative to TEE for LAAO procedures and may improve procedural efficiency and safety.