Integration of intracardiac echocardiographic imaging of the left atrium with electroanatomic mapping data for pulmonary vein isolation: first-in-Greece experience with the CartoSound™ system and brief literature review.

Introduction: Intracardiac echocardiography (ICE) offers the ability to image the left atrium in order to reconstruct a three-dimensional model that can be integrated with electroanatomic data to guide pulmonary vein isolation. We report a case series representing the first-in-Greece experience with the CartoSound module. Methods: Patients with paroxysmal or persistent atrial fibrillation (AF) referred for pulmonary vein isolation were included in this case-series. The SoundStar ICE catheter was used to trace left atrial and pulmonary vein contours from the right atrium, the right ventricular outflow tract and the coronary sinus. Results: Eight patients (age 66.3 ± 1.6 years) are presented in this case-series report. Six of them (75%) had paroxysmal AF and the rest were in persistent AF for less than one year. The time for ICE imaging and left atrium three-dimensional reconstruction decreased from a median of 20.5 minutes (interquartile range 19.3-23.3) for the chronologically first four cases to a median of 16.5 minutes (interquartile range 14.517.0) for the chronologically last four cases (p=0.02). The procedure was completed in all cases. No significant periprocedural complications were encountered. Acute success, with restoration of sinus rhythm, was achieved in both patients with persistent AF. Seven of the eight patients (87.5%) were AF-free in 48-hour Holter recordings one week after the procedure. Conclusion: ICE integration into three-dimensional electroanatomic reconstruction of the left atrium provides reliable guidance for pulmonary vein isolation. It appears that this modality is a sound alternative to magnetic resonance and computed tomography image data registration, although randomized comparisons are lacking.