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Corresponding author: Takehiro Kimura, MD, PhD, Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku Tokyo, Japan 160-8582. Tel.: +81-3-3353-1211; fax: +81-3-5363-3875.
A 76-year-old man with hypertension and congestive heart failure (CHADS2 [Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack] = 3; CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age [≥75 y], Diabetes, Stroke/Transient
Ischemic Attack, Vascular Disease, Age [65-74 y], Sex [Female] = 4) underwent catheter
ablation for 7-month persistent atrial fibrillation (AF). Intracardiac echocardiography
(ICE) (Soundstar Biosense Webster, Diamond Bar, CA) advanced in the pulmonary artery
(PA) through the right atrium (RA) and the right ventricle showed no thrombi in the
left atrial appendage (LAA) with a flow velocity of 7-18 cm/s during AF. Both pulmonary
veins were isolated circumferentially 12 hours after the last intake of dabigatran.
AF was terminated by intracardiac cardioversion, followed by linear ablation at the
lateral mitral isthmus to treat the induced atrial tachycardia. At the end of the
session, ICE imaging revealed a solid 3 × 4 mm mobile mass in the tip of the LAA (Fig. 1A-C; Video 1 view video online) observed from the PA (Fig. 1D). The activated clotting time was maintained over 300 seconds throughout the procedure
by intravenous administration of heparin. Before ablation, examination by cardiac
computed tomography detected a remarkable incomplete enhancement in the LAA without
thrombi (Fig. 1E). The left atrial size on transthoracic echocardiography was 4.6 cm, and the ostial
flow velocity of the LAA measured using transesophageal echocardiography was 30-36
cm/s during AF with evidence of spontaneous echo contrast without thrombi (Fig. 1F). LAA angiography during ablation showed no defect in the LAA.
Figure 1Images of the 5-second ICE (Biosense Webster, Diamond Bar, CA) (A-C; Video 1, view video online 1) and CARTO (Biosense Webster) (D, left anterior oblique view) during ablation. Computed tomographic scan (E) and transesophageal echocardiogram (F) before ablation are shown.
A prospective comparison of cardiac imaging using intracardiac echocardiography with transesophageal echocardiography in patients with atrial fibrillation: the intracardiac echocardiography guided cardioversion helps interventional procedures study.
view video online) observed from the PA (Fig. 1D). The activated clotting time was maintained over 300 seconds throughout the procedure
by intravenous administration of heparin. Before ablation, examination by cardiac
computed tomography detected a remarkable incomplete enhancement in the LAA without
thrombi (Fig. 1E). The left atrial size on transthoracic echocardiography was 4.6 cm, and the ostial
flow velocity of the LAA measured using transesophageal echocardiography was 30-36
cm/s during AF with evidence of spontaneous echo contrast without thrombi (Fig. 1F). LAA angiography during ablation showed no defect in the LAA.
