A Novel Method for Nonfluoroscopic Catheter-Based Electroanatomical Mapping of the Heart

Gepstein, Lior; Hayam, Gal; Ben‐Haim, Shlomo A.

doi:10.1161/01.cir.95.6.1611

Cited by 670 publications

(411 citation statements)

References 13 publications

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“…For comparison, electro-anatomic mapping systems provide a mean tracking error of 0.7 mm [24] which is comparable to our mean tracking error of 0.58 mm. In addition, our reference catheter, the circumferential mapping catheter, is directly at the site of ablation.…”

Section: Discussionsupporting

confidence: 79%

Constrained 2-D/3-D Registration for Motion Compensation in AFib Ablation Procedures

Brost

Wimmer

Liao

et al. 2011

Information Processing in Computer-Assisted Interventions

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Abstract. Fluoroscopic overlay images rendered from pre-operative volumetric data can provide additional guidance for physicians during catheter ablation procedures for treatment of atrial fibrillation (AFib). As these overlay images are compromised by cardiac and respiratory motion, motion compensation methods have been proposed. The approaches so far either require simultaneous biplane imaging for 3-D motion compensation or, in case of mono-plane X-ray imaging, provide only a limited 2-D functionality. To overcome the downsides of the previously suggested methods, we propose a new approach that facilitates full 3-D motion compensation even if only mono-plane X-ray views are available. To this end, we use constrained model-based 2-D/3-D registration to track a circumferential mapping catheter which is commonly used during AFib catheter ablation procedures. Our approach yields an average 2-D tracking error of 0.6 mm and an average 3-D tracking error of 2.1 mm.

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Section: Discussionsupporting

confidence: 79%

Constrained 2-D/3-D Registration for Motion Compensation in AFib Ablation Procedures

Brost

Wimmer

Liao

et al. 2011

Information Processing in Computer-Assisted Interventions

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“…Distances between the pacing and reference sites were measured with a mapping system that has a spatial resolution of 0.42Ϯ0.05 mm. 7 During pacing at threshold, the conduction time (T TH) from the pacing site to the reference sites was measured. The mean conduction velocities (CVs) in the directions toward the reference catheters were measured as the distance divided by the conduction time (T TH ).…”

Section: Effect Of Stimulus Strength On the Virtual Electrodementioning

confidence: 99%

Electrically Unexcitable Scar Mapping Based on Pacing Threshold for Identification of the Reentry Circuit Isthmus

et al. 2002

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Background-We hypothesized that delineating electrically unexcitable scar (EUS) within low-voltage infarct regions will locate reentry circuit isthmuses by defining their borders. The pacing threshold and electrogram amplitude that best determines EUS is unknown. Methods and Results-The change in dimension of the virtual electrode was estimated in 11 patients and observed to increase by 4.4Ϯ2.5 mm as stimulus strength increases from threshold (2.9Ϯ1.8 mA) to 10 mA. EUS was defined as a threshold Ͼ10 mA. In 14 consecutive patients, mapping and ablation of ventricular tachycardia (VT) were performed using an electroanatomic mapping system. During sinus rhythm, unipolar pacing was performed at sites with bipolar electrogram amplitude Ͻ1.5 mV. EUS regions were marked on the maps. Reentry circuit isthmuses were identified by entrainment mapping or pace mapping, and ablation was performed. EUS was identified in the infarct in all 14 patients (11.8Ϯ13.9 cm 2 ). All 20 VT circuit isthmuses identified were adjacent to EUS. Although electrogram amplitude correlated with pacing threshold (rϭ0.64, PϽ0.0001), many isthmuses had very low-amplitude electrograms, and EUS could not be identified from electrogram amplitude alone. RF ablation lines connecting selected EUS regions abolished all inducible VTs in 10 patients (71%); spontaneous VT was markedly reduced during follow-up (from 142Ϯ360 to 0.9Ϯ2.0 episodes per month, Pϭ0.002). Conclusions-This

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“…Although successful in the treatment of simple arrhythmias originating in and around the pulmonary veins, these devices are poorly suited for treating complex arrhythmias, such as persistent atrial fibrillation (10)(11)(12)(13), that arise from various sites inside the left atrium. Other classes of devices have demonstrated the utility of spatiotemporal voltage mapping using various modes of operation, including noninvasive surface mapping designs (14,15), epicardial voltage-mapping "socks" (16)(17)(18)(19)(20), and endocardial contact and noncontact catheters, with densities approaching 64 electrodes (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). These solutions all exploit arrays of passive metal wirebased electrodes integrated on wearable vests and socks (14)(15)(16)(17)(18)(19)(20) or catheter systems (21)(22)(23)(24)(25)(26) for mapping of complex arrhythmias.…”

mentioning

confidence: 99%

Electronic sensor and actuator webs for large-area complex geometry cardiac mapping and therapy

Kim

Ghaffari

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

221

167

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Curved surfaces, complex geometries, and time-dynamic deformations of the heart create challenges in establishing intimate, nonconstraining interfaces between cardiac structures and medical devices or surgical tools, particularly over large areas. We constructed large area designs for diagnostic and therapeutic stretchable sensor and actuator webs that conformally wrap the epicardium, establishing robust contact without sutures, mechanical fixtures, tapes, or surgical adhesives. These multifunctional web devices exploit open, mesh layouts and mount on thin, bio-resorbable sheets of silk to facilitate handling in a way that yields, after dissolution, exceptionally low mechanical moduli and thicknesses. In vivo studies in rabbit and pig animal models demonstrate the effectiveness of these device webs for measuring and spatially mapping temperature, electrophysiological signals, strain, and physical contact in sheet and balloon-based systems that also have the potential to deliver energy to perform localized tissue ablation.flexible electronics | semiconductor nanomaterials | stretchable electronics | implantable biomedical devices | cardiac electrophysiology C ardiac arrhythmias occur in all component structures and 3D regions of the heart, resulting in significant challenges in diagnosis and treatment of precise anatomic targets (1). Many common arrhythmias, including atrial fibrillation and ventricular tachycardia, originate in endocardial substrates and then propagate in the transverse direction to affect epicardial regions (1, 2). Characterizing arrhythmogenic activity at specific regions of the heart is thus critical for establishing the basis for definitive therapies such as cardiac ablation (3). Advanced tools that offer sufficient spatial resolution (<1 mm) and intimate mechanical coupling with myocardial tissue, but without undue constraints on natural motions, would therefore be of great clinical importance (4-6). To date, cardiac ablation procedures have largely relied on point ablation catheters deployed in the endocardial space (1, 5, 7-9). Although successful in the treatment of simple arrhythmias originating in and around the pulmonary veins, these devices are poorly suited for treating complex arrhythmias, such as persistent atrial fibrillation (10-13), that arise from various sites inside the left atrium. Other classes of devices have demonstrated the utility of spatiotemporal voltage mapping using various modes of operation, including noninvasive surface mapping designs (14, 15), epicardial voltage-mapping "socks" (16-20), and endocardial contact and noncontact catheters, with densities approaching 64 electrodes (21-31). These solutions all exploit arrays of passive metal wirebased electrodes integrated on wearable vests and socks (14-20) or catheter systems (21-26) for mapping of complex arrhythmias. Building such mesh structures requires manual assembly and is only possible because the individual wires are millimeter scale in diameter and thus sufficiently large to be threaded to form a mesh.Fo...

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A Novel Method for Nonfluoroscopic Catheter-Based Electroanatomical Mapping of the Heart

Cited by 670 publications

References 13 publications

Constrained 2-D/3-D Registration for Motion Compensation in AFib Ablation Procedures

Constrained 2-D/3-D Registration for Motion Compensation in AFib Ablation Procedures

Electrically Unexcitable Scar Mapping Based on Pacing Threshold for Identification of the Reentry Circuit Isthmus

Electronic sensor and actuator webs for large-area complex geometry cardiac mapping and therapy

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