Abstract 1367 The DUS4ABL strategy: a systematic ultrasound guided approach for left atrial and ventricular ablation procedures

Background

The ultrasound evolved as an indispensable tool to guide electrophysiological (EP) procedures (i.e., gain femoral access, transseptal puncture or exclude pericardial effusion). However, there are no data regarding the course and safety features of ablation procedures in a systematic ultrasound-guided approach.

Aims

The aim of this study was to investigate if a systematic ultrasound-guided approach consisting of four elements (1. transesophageal echocardiography (TEE) to rule out left atrial thrombi in the EP laboratory, 2. vascular ultrasound to guide vascular access, 3. TEE to guide the transseptal puncture, and 4. transthoracic echocardiography (TTE) for ruling out pericardial effusion peri- and post procedure) could reduce overall rate of complications as well as fluoroscopy time and dose: the DUS4ABL strategy.

Methods

Between January 2018 and December 2021, a total of 149 consecutive patients underwent left atrial or left ventricular EP procedures guided by the DUS4ABL strategy and were compared to a historical cohort of 299 patients undergoing the same type of EP procedures earlier using only TTE post procedure to rule out pericardial effusion (standard group: femoral access by palpation only and transseptal puncture by fluoroscopy and pressure guided).

Comorbidities, medication, and epidemiological data were recorded and analyzed. Rates of major complications, procedure time, fluoroscopy time and dose were compared in both groups.

Results

All 448 patients (43% female) were included into the final analysis: 43.8% of patients presented with paroxysmal atrial fibrillation, 35.3% had persistent atrial fibrillation, 10.9% had atrial tachycardia and 10% arrhythmias arising from the left ventricle. Baseline characteristics of the patients did not differ significantly between both groups.

The overall complication rate was significantly lower in the DUS4ABL group compared to the standard group: 0 complications vs. 11 complications (3.6%) in the standard group (p = 0.01). The complications in the standard group included four pericardial tamponades and seven pseudoaneurysms of the femoral artery, all of them were successfully managed. Strokes, atrio-esophageal fistula, phrenic lesions or death did not occur in either of the two groups.

The procedure times did not differ significantly in both groups, whereas the fluoroscopy time and dose were significantly lower in the DUS4ABL as compared to the standard group (p=0.002 and p=0.013).

Conclusion

The DUS4ABL strategy significantly reduced the overall complication rate, and resulted in significantly decreased fluoroscopy time and dose, without significantly affecting the procedural time.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
The DUS4ABL strategy: a systematic ultrasound guided approach for left atrial and ventricular ablation procedures
N. Augustin¹, M. Spieker¹, D. Glöckner¹, S. Angendohr¹, J. Schmidt¹, C. Brinkmeyer¹, M. Kelm¹, O. R. Rana¹, A. G. Bejinariu¹
¹Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf;
Background The ultrasound evolved as an indispensable tool to guide electrophysiological (EP) procedures (i.e., gain femoral access, transseptal puncture or exclude pericardial effusion). However, there are no data regarding the course and safety features of ablation procedures in a systematic ultrasound-guided approach. Aims The aim of this study was to investigate if a systematic ultrasound-guided approach consisting of four elements (1. transesophageal echocardiography (TEE) to rule out left atrial thrombi in the EP laboratory, 2. vascular ultrasound to guide vascular access, 3. TEE to guide the transseptal puncture, and 4. transthoracic echocardiography (TTE) for ruling out pericardial effusion peri- and post procedure) could reduce overall rate of complications as well as fluoroscopy time and dose: the DUS4ABL strategy. Methods Between January 2018 and December 2021, a total of 149 consecutive patients underwent left atrial or left ventricular EP procedures guided by the DUS4ABL strategy and were compared to a historical cohort of 299 patients undergoing the same type of EP procedures earlier using only TTE post procedure to rule out pericardial effusion (standard group: femoral access by palpation only and transseptal puncture by fluoroscopy and pressure guided). Comorbidities, medication, and epidemiological data were recorded and analyzed. Rates of major complications, procedure time, fluoroscopy time and dose were compared in both groups. Results All 448 patients (43% female) were included into the final analysis: 43.8% of patients presented with paroxysmal atrial fibrillation, 35.3% had persistent atrial fibrillation, 10.9% had atrial tachycardia and 10% arrhythmias arising from the left ventricle. Baseline characteristics of the patients did not differ significantly between both groups. The overall complication rate was significantly lower in the DUS4ABL group compared to the standard group: 0 complications vs. 11 complications (3.6%) in the standard group (p = 0.01). The complications in the standard group included four pericardial tamponades and seven pseudoaneurysms of the femoral artery, all of them were successfully managed. Strokes, atrio-esophageal fistula, phrenic lesions or death did not occur in either of the two groups. The procedure times did not differ significantly in both groups, whereas the fluoroscopy time and dose were significantly lower in the DUS4ABL as compared to the standard group (p=0.002 and p=0.013). Conclusion The DUS4ABL strategy significantly reduced the overall complication rate, and resulted in significantly decreased fluoroscopy time and dose, without significantly affecting the procedural time.
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