Intracardiac echocardiography for left ventricular diastolic function assessment during atrial fibrillation ablation

Left ventricular (LV) diastolic dysfunction is associated with the development of atrial fibrillation (AF) and risk of recurrence after ablation. The use of an intracardiac echocardiography (ICE) for diastolic function assessment during ablation procedures has not been evaluated.

To evaluate the feasibility and utility of ICE obtained measures of LV diastolic function including peak tricuspid regurgitation velocity, trans-mitral flow velocity, mitral annular tissue Doppler velocities, and pulmonary vein flow velocities in patients undergoing AF ablation.

We conducted a single-center, prospective evaluation of patients undergoing AF ablation between 2022 and 2024. During sinus rhythm, diastolic parameters were measured with the ICE catheter and direct left atrial pressure (LAP) was recorded prior to AF ablation. Elevated LAP was defined as ≥ 12 mmHg. ICE measured diastolic parameters were compared with those measured on transthoracic echocardiography (TTE).

A total of 152 patients (53% male, 69 ± 12 years old, mean CHA₂DS₂-VASc score of 3 ± 2) were analyzed, of which 80 had normal LAP (< 12 mmHg) by direct measurement. Several ICE parameters were found to be significantly associated with mean LAP, including greater peak tricuspid regurgitation velocity (β = 3.5; p = 0.005) and average E/e' (β = 0.7; p < 0.001). In multivariable model, post-procedure intravenous diuretics were more commonly required in patients with abnormal diastolic function by ICE (mitral E/A OR = 8.1; average E/e' OR = 24.2).

ICE can be used to assess diastolic function with traditional parameters correlating with both TTE diastolic function and LAP. ICE measures of restrictive filling are associated with the need for post-procedural intravenous diuretics.