Time-resolved three-dimensional imaging of the left atrium and pulmonary veins in the interventional suite - A comparison between muttisweep gated rotational three-dimensional reconstructed fluoroscopy and multislice computed tomography

Cardiac Arrhythmia Service, Stanford University Medical School, Stanford, California, USA.
Heart rhythm: the official journal of the Heart Rhythm Society (Impact Factor: 5.08). 05/2008; 5(4):513-9. DOI: 10.1016/j.hrthm.2007.12.027
Source: PubMed


Cardiac computed tomography (CT) is commonly used to visualize left atrial (LA) anatomy for ablation of atrial fibrillation. We have developed a new imaging technique that allows acquisition and visualization of three-dimensional (3D) cardiac images in the catheter lab.
We sought to compare LA and pulmonary vein (PV) dimensions acquired using gated multisweep rotational fluoroscopy (C-arm CT) system and multislice computed tomography (MSCT) in an in vivo porcine model.
A Siemens AXIOM Artis dTA C-arm system (Siemens AG, Medical Solutions) was modified to allow acquisition of four bidirectional sweeps during synchronized acquisition of the electrocardiogram signal to allow retrospective gating. C-arm CT image volumes were then reconstructed. Gated MSCT (SOMATOM Sensation 16 and 64, Siemens AG, Medical Solutions) and C-arm CT images were acquired in six animals. The two main PV diameters were measured in orthogonal axes. LA volumes were calculated. C-arm CT measurements were compared with the MSCT measurements.
The average PV diameters using the C-arm CT were 2.24 x 1.35 cm, versus 2.27 x 1.38 cm for CT. The average difference was 0.034 cm (1.9%) between the C-arm CT and standard CT. The average LA volume using MSCT was 49.1 +/- 12.7 cm(3), as compared with 51.0 +/- 8.7 cm(3) obtained by the C-arm CT. The average difference between the C-arm CT and the MSCT was 1.9 cm(3) (3.7%). There were no significant differences in either the PV or LA measurements.
Visualization of 3D cardiac anatomy during ablation procedures is possible and highly accurate. The 3D cardiac reconstructions acquired during ablation procedures will be valuable for procedural planning and guidance.

63 Reads
  • Source
    • "The potential advantage of this strategy is the fused display of the actual, real-time fluoroscopic images together with the highly detailed images from CT or MRI [3] [4] [5] [6]. In fact, state-of-the art C-arm systems [7] [8] facilitating 3-D tomographic reconstruction can also be used to obtain volumetric data sets of the heart [9] [10] [11] [12] [13] [14]. Two examples for bi-plane C-arm systems are shown in Figure 1. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In many cases, radio-frequency catheter ablation of the pulmonary veins attached to the left atrium still involves fluoroscopic image guidance. Two-dimensional X-ray navigation may also take advantage of overlay images derived from static pre-operative 3D volumetric data to add anatomical details otherwise not visible under X-ray. Unfortunately, respiratory motion may impair the utility of static overlay images for catheter navigation. We developed a novel approach for image-based 3D motion estimation and compensation as a solution to this problem. It is based on 3D catheter tracking which, in turn, relies on 2D/3D registration. To this end, a bi-plane C-arm system is used to take X-ray images of a special circumferential mapping catheter from two directions. In the first step of the method, a 3D model of the device is reconstructed. Three-dimensional respiratory motion at the site of ablation is then estimated by tracking the reconstructed catheter model in 3D based on bi-plane fluoroscopy. Phantom data and clinical data were used to assess model-based catheter tracking. Our phantom experiments yielded an average 2D tracking error of 1.4mm and an average 3D tracking error of 1.1mm. Our evaluation of clinical data sets comprised 469 bi-plane fluoroscopy frames (938 monoplane fluoroscopy frames). We observed an average 2D tracking error of 1.0 + or - 0.4mm and an average 3D tracking error of 0.8 + or - 0.5mm. These results demonstrate that model-based motion-compensation based on 2D/3D registration is both feasible and accurate.
    Full-text · Article · Oct 2010 · Medical image analysis
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The paper presents an efficient approach to perform global interconnect sizing and spacing (GISS) for multiple nets to minimize interconnect delays with consideration of coupling capacitance, in addition to area and fringing capacitances. We introduce the formulation of symmetric and asymmetric wire sizing and spacing. We prove two important results on the symmetric and asymmetric effective fringing properties which lead to a very effective bound computation algorithm to compute the upper and lower bounds of the optimal wire sizing and spacing solution for all nets under consideration. Our experiments show that in most cases the upper and lower bounds meet quickly after a few iterations and we actually obtain the optimal solution. To our knowledge, this is the first in depth study of global wire sizing and spacing for multiple nets with consideration of coupling capacitance. Experimental results show that our GISS solutions lead to substantially better delay reduction than existing single net wire sizing solutions without consideration of coupling capacitance.
    Preview · Conference Paper · Jan 1997
  • [Show abstract] [Hide abstract]
    ABSTRACT: The handoff delay required for Mobile IPv6 is analysed by investigating the concerned handoff delay components. From testbed experiments, it is shown that the measured handover delays are almost the same as the analytical results.
    No preview · Conference Paper · Oct 2004
Show more