Feasibility and validation of registration of three-dimensional left atrial models derived from computed tomography with a noncontact cardiac mapping system

Sra, Jasbír; Krum, David; Hare, John; Okerlund, Darin; Thompson, Helen; Vass, Melissa; Schweitzer, Jeff; Olson, Eric; Foley, W D; Akhtar, Masood

doi:10.1016/j.hrthm.2004.10.035

Cited by 79 publications

(65 citation statements)

References 14 publications

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“…4 Fiducial points (≥ 3 non collinear points) were manually inserted in the form of pacing leads into the LA of a canine model and CT images were recorded. Following segmentation of the LA, a wire-frame model of the LA was imported to the noncontact, multielectrode array-based EnSite mapping system.…”

Section: Point and Surface-based Registrationmentioning

confidence: 99%

“…Intrasubject intermodal registration using 3D imaging modalities is an area of current focus with regards to radiofrequency catheter ablation procedures. [3][4][5][6][7][8][9][10][11] Cardiac motion of the heart and interpatient variability of anatomical features make the registration of cardiac images a unique challenge. Objective validation of the registration technique is, therefore, necessary before its utility as a tool for image-guided therapy can be properly assessed.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Image Registration

Sra¹

2008

J.AFIB

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Long procedure time and somewhat suboptimal results hinder the widespread use of catheter ablation of complex arrhythmias such as atrial fibrillation (AF). Due to lack of contrast differentiation between the area of interest and surrounding structures in a moving organ like heart, there is a lack of proper intraprocedural guidance using current imaging techniques for ablation. Cardiac image registration is currently under investigation and is in clinical use for AF ablation. Cardiac image registration, which involves integration of two images in the context of left atrium (LA), is intermodal, with the acquired image and the real-time reference image residing in different image spaces, and involves optimization, where one image space is transformed into the other. Unlike rigid body registration, cardiac image registration is unique and challenging due to cardiac motion during the cardiac cycle and due to respiration. This review addresses the basic principles of the emerging technique of registration and the inherent limitations as they relate to cardiac imaging and registration

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Section: Point and Surface-based Registrationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiac Image Registration

Sra¹

2008

J.AFIB

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“…27,28 I n such patients, the lesion from the right pulmonary veins to the mitral annulus may be particularly important in prevention of post-procedure left atrial flutter. 29 The addition of right atrial lesions appears to increase freedom from recurrent AF and atrial flutter, but their importance is controversial (30). However, creation of right atrial lesions is simple and safe, and we currently favor their incorporation at the time of surgical ablation.…”

Section: 24mentioning

confidence: 99%

Surgical Treatment of Atrial Fibrillation.

Gillinov¹

2008

J.AFIB

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Atrial fibrillation (AF) is now commonly treated at the time of valvular heart surgery or coronary artery bypass grafting. Surgical ablation of AF, which is predicated upon the Maze procedure, includes creation of lines of conduction block and excision of the left atrial appendage. A full bi-atrial lesion set is associated with success in 80% to 95% of patients and virtually eliminates the risk of late stroke. A complex but safe operation, the classic cut-and-sew Maze procedure has been applied by relatively few surgeons. However, recent advances in understanding of the pathogenesis of AF and development of new ablation technologies enable surgeons to perform pulmonary vein isolation, create linear left and right atrial lesions, and remove the left atrial appendage rapidly and safely. Lesions are created under direct vision, minimizing the risk of damage to the pulmonary veins and adjacent mediastinal structures. Recently developed instrumentation now enables thoracoscopic and keyhole approaches, facilitating extension of epicardial AF ablation and excision of the left atrial appendage to patients with isolated AF and no other indication for cardiac surgery. In addition, novel devices designed specifically for minimally invasive epicardial exclusion of the left atrial appendage will broaden the range of treatment options for patients with AF, possibly eliminating the need for anticoagulation in selected patients.

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“…The process of imaging and segmentation of the left atrium has been described previously. 6 Patients were kept stationary and level during CT imaging to avoid introduction of any rotational errors. To eliminate misregistration due to cardiac motion, retrospective ECG-gated reconstruction of the axial slices was performed at the point in the cardiac cycle that yielded the best image quality.…”

Section: Imaging and Segmentationmentioning

confidence: 99%

“…ECG-gated cardiac imaging, using computed tomography (CT) and segmentation, allows 3D rendering of the left atrium free of motion. 5,6 The combination of the 2 modalities could thus differentiate the left atrium and the PVs from the surrounding structures and help navigate the mapping and ablation catheter to the appropriate locations. In addition, availability of real-time fluoroscopy allows for rapid correlation of anatomic structures and catheter location.…”

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confidence: 99%

Registration of Three-Dimensional Left Atrial Computed Tomographic Images With Projection Images Obtained Using Fluoroscopy

et al. 2005

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Background-Anatomic structures such as the left atrium and the pulmonary veins (PVs) are not delineated by fluoroscopy because there is no contrast differentiation between them and the surrounding anatomy. Representation of an anatomic structure via a 3D model obtained from computed tomography (CT) imaging and subsequent projection of these images over the fluoroscopy system may help in navigation of the mapping and ablation catheter to the appropriate sites during electrophysiology procedures. Methods and Results-In this feasibility study, in vitro experiments were performed with a plastic heart model (phantom) with 2 catheters or radiopaque platinum beads placed in the phantom at the time of CT imaging and fluoroscopy. Subsequently, 20 consecutive patients underwent contrast-enhanced, ECG-gated CT scanning. Left atrial volumes were generated from the reconstructed data at Ϸ75% of the R-R interval during the cardiac cycle. Similarly, the superior vena cava and the coronary sinus were also reconstructed from these images. During the electrophysiology procedure, digital records (cine sequences) were obtained. Using predetermined algorithms, both the phantom model and the patients' 3D left atrial models derived from the CT were registered with projection images of fluoroscopy. Registration was performed with a transformation that linked the superior vena cava and the coronary sinus from the CT model with a catheter placed inside the coronary sinus via the superior vena cava. Registration was successfully accomplished with the plastic phantom and in all 20 patients. Registration accuracy was assessed in the phantom by assessing the overlapping beads seen both in the CT and the fluoroscopy images. The mean registration error was 1.4 mm (range 0.9 to 2.3 mm). Accuracy of the registered images was assessed in patients with recordings from a basket catheter placed sequentially in the superior PVs and by injecting contrast into the PVs to assess overlapping of contrast-filled PVs with the corresponding vessels on the registered images. The images could be calibrated quite accurately. Any rotational error, which was usually minor, could be corrected by rotating the images as needed. Conclusions-Registration

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Feasibility and validation of registration of three-dimensional left atrial models derived from computed tomography with a noncontact cardiac mapping system

Cited by 79 publications

References 14 publications

Cardiac Image Registration

Cardiac Image Registration

Surgical Treatment of Atrial Fibrillation.

Registration of Three-Dimensional Left Atrial Computed Tomographic Images With Projection Images Obtained Using Fluoroscopy

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