Integrated Electroanatomic Mapping With Three-Dimensional Computed Tomographic Images for Real-Time Guided Ablations

Abstract

Background-New ablation strategies for atrial fibrillation or nonidiopathic ventricular tachycardia are increasingly based on anatomic consideration and require the placement of ablation lesions at the correct anatomic locations. This study sought to evaluate the accuracy of the first clinically available image integration system for catheter ablation on 3-dimensional (3D) computed tomography (CT) images in real time. Methods and Results-After midline sternotomy, 2.3-mm CT fiducial markers were attached to the epicardial surface of each cardiac chamber in 9 mongrel dogs. Detailed 3D cardiac anatomy was reconstructed from contrast-enhanced, high-resolution CT images and registered to the electroanatomic maps of each cardiac chamber. To assess accuracy, targeted ablations were performed at each of the fiducial markers guided only by the reconstructed 3D images. At autopsy, the position error was 1.9Ϯ0.9 mm for the right atrium, 2.7Ϯ1.2 mm for the right ventricle, 1.8Ϯ1.0 mm for the left atrium, and 2.3Ϯ1.1 mm for the left ventricle. To evaluate the system's guidance of more complex clinical ablation strategies, ablations of the cavotricuspid isthmus (nϭ4), fossa ovalis (nϭ4), and pulmonary veins (nϭ6) were performed, which resulted in position errors of 1.8Ϯ1.5, 2.2Ϯ1.3, and 2.1Ϯ1.2 mm, respectively. Retrospective analysis revealed that a combination of landmark registration and the target chamber surface registration resulted in Ͻ3 mm accuracy in all 4 cardiac chambers. Conclusions-Image

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…737,738 Another approach involves use of 3D rotational angiography images that can be merged with live two-dimensional fluoroscopy. 739 This approach is rarely used at the present time.…”

Cardiac cycle–dependent left atrial dynamics: Implications for catheter ablation of atrial fibrillation

“…Manipulation of an ablation catheter in the left atrium (LA) can be time consuming and involve significant fluoroscopy, but new technologies are evolving to facilitate catheter navigation and reduce procedure and fluoroscopy times (4)(5)(6)(7). Recently, mapping systems have incorporated three-dimensional (3D) cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) imaging of the LA to facilitate nonfluoroscopic mapping (8)(9)(10)(11). These data sets can be displayed side by side with a catheter geometry, providing an anatomical reference (Digital Image Fusion ™ , EnSite 5.01 workstation, Endocardial Solutions, Inc., MN), or as an image registered with the catheter geometry (Carto XP ™ , Biosense Webster, Diamond Bar, CA and EnSite Fusion ™ , Endocardial Solutions, Inc., MN).…”

Cardiac Image Registration

“…5,[8][9][10][11] A combination of landmark and surface registration is used to register CT or MR with the CARTO system. Initially, several landmarks, usually 3, are manually chosen and annotated.…”

“…Dong et al, 8 attached 2.3 mm CT fiducial markers to the epicardial surface of each cardiac chamber in 9 mongrel dogs. CT images were registered to the electroanatomic maps of each cardiac chamber.…”

“…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.…”