Real-time integration of intracardiac echocardiography and multislice computed tomography to guide radiofrequency catheter ablation for atrial fibrillation.
ABSTRACT Multislice computed tomography (MSCT) integration is commonly used to guide radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). MSCT provides detailed anatomical information but lacks the ability to provide real-time anatomy during RFCA. Intracardiac echocardiography (ICE) allows real-time visualization of cardiac structures.
The purpose of this study was to investigate the feasibility of three-dimensional (3D) anatomical mapping of the left atrium (LA) with ICE and integrating the 3D map with MSCT to facilitate RFCA for AF.
In 17 patients undergoing RFCA for AF, 3D mapping of the LA was performed with ICE using a new mapping system that allows tracking of a new ICE probe. On each ICE image, endocardial contours were traced and used to generate a 3D map of the LA and pulmonary veins (PVs). A preprocedurally acquired MSCT image of the LA was then integrated with the 3D map. Additionally, PV assessment with ICE was compared with MSCT.
Accurate 3D mapping could be performed in all patients with a mean number of 31.1 +/- 8.5 contours. Integration with MSCT resulted in a mean distance between the MSCT and ICE contours of 2.2 +/- 0.3 mm for the LA and PVs together and of 1.7 +/- 0.2 mm around the PV ostia specifically. Agreement in the assessment of PV anatomy and diameters between ICE and MSCT was excellent.
Three-dimensional ICE mapping of the LA is feasible. The 3D map created with ICE can be merged with MSCT to facilitate RFCA for AF.
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ABSTRACT: The left atrial appendage (LAA) is a common source of cardiac thrombus formation and systemic embolism. It is a 'blind' cul-de-sac and multilobed anatomic structure with variable anatomy. Therefore, it requires detailed evaluation in multiple imaging planes to evaluate for thrombus formation. Transesophageal echocardiography is the most common imaging modality used to rule out LAA thrombus. Doppler imaging enhances understanding of LAA function. 3D imaging of the LAA with live 3D transesophageal echocardiography, computed tomography and MRI may be further utilized for thrombus detection, as well as for sizing, and the development of new transcatheter occluder devices for LAA to prevent thrombus formation is needed.Expert Review of Cardiovascular Therapy 01/2010; 8(1):65-75.
- Europace 08/2009; 11(9):1253-4. · 2.77 Impact Factor
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ABSTRACT: Integration of preprocedural delayed enhanced magnetic resonance imaging (DE-MRI) with electroanatomical voltage mapping (EAVM) may provide additional high-resolution substrate information for catheter ablation of scar-related ventricular tachycardias (VT). Accurate and fast image integration of DE-MRI with EAVM is desirable for MR-guided ablation. Twenty-six VT patients with large transmural scar underwent catheter ablation and preprocedural DE-MRI. With different registration models and EAVM input, 3 image integration methods were evaluated and compared to the commercial registration module CartoMerge. The performance was evaluated both in terms of distance measure that describes surface matching, and correlation measure that describes actual scar correspondence. Compared to CartoMerge, the method that uses the translation-and-rotation model and high-density EAVM input resulted in a registration error of 4.32±0.69 mm as compared to 4.84 ± 1.07 (P <0.05); the method that uses the translation model and high-density EAVM input resulted in a registration error of 4.60 ± 0.65 mm (P = NS); and the method that uses the translation model and a single anatomical landmark input resulted in a registration error of 6.58 ± 1.63 mm (P < 0.05). No significant difference in scar correlation was observed between all 3 methods and CartoMerge (P = NS). During VT ablation procedures, accurate integration of EAVM and DE-MRI can be achieved using a translation registration model and a single anatomical landmark. This model allows for image integration in minimal mapping time and is likely to reduce fluoroscopy time and increase procedure efficacy.Journal of Cardiovascular Electrophysiology 09/2011; 23(1):74-80. · 3.48 Impact Factor