{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:58:03Z","timestamp":1777424283308,"version":"3.51.4"},"reference-count":20,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T00:00:00Z","timestamp":1735257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The safety and efficacy of electrophysiological (EP) procedures using ultrasound (US) guidance are being increasingly studied. We investigated if a systematic workflow with ultrasound guidance (the US4ABL), comprising four steps (transesophageal echocardiography (TEE) for left atrial thrombus exclusion, US of the groin vessels to guide femoral access, TEE-aided transseptal puncture, and transthoracic echocardiography (TTE) for exclusion of pericardial tamponade after the procedure), reduces the number of complications and fluoroscopy duration and dose. Methods: A total of 212 consecutive patients underwent left-sided ablations using the US4ABL workflow and were compared to a group of 299 patients who underwent the same type of ablations using post-procedural TTE to exclude tamponade (standard group: venous and\/or arterial access by palpation and fluoroscopy, and pressure guided transseptal puncture). Complications, procedural duration, fluoroscopy duration, and dose were compared. Results: The cohort included 511 patients (42% female); 43.8% of patients suffered from paroxysmal atrial fibrillation (AF), 35.4% presented with persistent AF, 10.7% underwent the procedure was for atrial tachycardia, and 10% of patients had premature ventricular contractions. The complication rate in the US4ABL group was lower compared to the standard group: 0 complications vs. 11 complications (3.7%, mainly vascular and pericardial), respectively (p = 0.005). The procedure times were lower in the US4ABL group (p &lt; 0.01), whereas the fluoroscopy time and dose did not differ significantly. Conclusions: A fully ultrasound-guided (US4ABL) workflow for left atrial and ventricular electrophysiology procedures reduces the complication rate and the procedure time.<\/jats:p>","DOI":"10.3390\/jcm14010103","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T04:10:23Z","timestamp":1735618223000},"page":"103","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The US4ABL Strategy: A Systematic Ultrasound-Guided Approach for Left Atrial and Ventricular Ablation Procedures"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4820-3304","authenticated-orcid":false,"given":"Alexandru Gabriel","family":"Bejinariu","sequence":"first","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora","family":"Augustin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Spieker","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0388-7578","authenticated-orcid":false,"given":"Carsten","family":"auf der Heiden","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Angendohr","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz","family":"H\u00f6ckmann","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Clasen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rhythmology and Angiology, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of M\u00fcnster, 48231 Warendorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7784-762X","authenticated-orcid":false,"given":"Stefan","family":"Hartl","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Alfried Krupp Hospital, 45121 Essen, Germany"},{"name":"Department of Medicine, Witten\/Herdecke University, 58455 Witten, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5302-2874","authenticated-orcid":false,"given":"Hisaki","family":"Makimoto","sequence":"additional","affiliation":[{"name":"Data Science Center\/Cardiovascular Center, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-City 329-0498, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5521-1265","authenticated-orcid":false,"given":"Lucas","family":"Busch","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"},{"name":"CARID, Cardiovascular Research Institute D\u00fcsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0060-1052","authenticated-orcid":false,"given":"Malte","family":"Kelm","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"},{"name":"CARID, Cardiovascular Research Institute D\u00fcsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Obaida","family":"Rana","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 D\u00fcsseldorf, Germany"},{"name":"CARID, Cardiovascular Research Institute D\u00fcsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1016\/j.jacc.2023.03.418","article-title":"Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation","volume":"81","author":"Benali","year":"2023","journal-title":"J. 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