Comparison of Two ICE-Guided Transseptal Puncture Strategies for Zero-Fluoroscopy AF Ablation-A Randomized Controlled...

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Transseptal puncture (TSP) is crucial for left atrial (LA) access during atrial fibrillation (AF) ablation.
• Intracardiac echocardiography (ICE) combined with electroanatomical mapping allows for zero-fluoroscopy TSP.
• Two distinct ICE-guided TSP strategies exist, but their comparative efficacy and safety are not well-established.

Purpose of the Study:

• To compare the efficiency, safety, and learning curves of two ICE-guided TSP strategies.
• To evaluate the effectiveness of these strategies in achieving successful LA access and pulmonary vein isolation.
• To assess complication rates and one-year AF recurrence for each strategy.

Main Methods:

• A prospective randomized controlled trial involving 43 patients undergoing first-time AF ablation.
• Patients were randomized to Protocol A (advancing sheath under ICE guidance) or Protocol B (using a mapping catheter for guidance).
• Key metrics included procedural duration, TSP metrics, learning curve, complications, and AF recurrence over one year.

Main Results:

• Zero fluoroscopy was achieved in all procedures without complications or crossover.
• Protocol A showed significantly shorter initial TSP times compared to Protocol B (8.5 vs. 12.0 minutes).
• Protocol B had a steeper learning curve, reaching comparable efficiency around 10 cases; both strategies had similar complication rates and one-year AF recurrence.

Conclusions:

• Both ICE-guided TSP strategies are safe and effective for zero-fluoroscopy AF ablation.
• Protocol A provides superior early procedural efficiency.
• Protocol B demonstrates rapid adaptability, highlighting the complementary roles of these strategies in radiation-free procedures.