Role of High-Resolution Image Integration to Visualize Left Phrenic Nerve and Coronary Arteries During Epicardial Ventricular Tachycardia Ablation

Yamashita, Seigo; Sacher, Frédéric; Mahida, Saagar; Berte, Benjamin; Lim, H.; Komatsu, Yuki; Amraoui, Sana; Denis, Arnaud; Derval, Nicolas; Laurent, François; Montaudon, Michel; Hocini, Mélèze; Haı̈ssaguerre, Michel; Jaı̈s, Pierre; Cochet, Hubert

doi:10.1161/circep.114.002420

Cited by 59 publications

(33 citation statements)

References 31 publications

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“…Images were processed using dedicated software (MUSIC; Liryc-Université de Bordeaux/Inria-Sophia Antipolis, France) to render patient-specific meshes of the cardiac chambers, epicardium, coronary sinus, and coronary arteries and left phrenic nerve in case of epicardial approach. 16 The structural substrate was segmented on imaging as areas of late gadolinium enhancement on MRI and/or areas of wall thinning <5 mm on MDCT. 9 The imaging model was registered to the mapping geometry using landmark-based registration and field scaling when using NavX system or landmarkbased registration and automatic surface registration when using CARTO system.…”

Section: What the Study Addsmentioning

confidence: 99%

Impact of New Technologies and Approaches for Post–Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up

Yamashita

Cochet

Sacher

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background— During the past years, many innovations have been introduced to facilitate catheter ablation of post–myocardial infarction ventricular tachycardia. However, the predictors of outcome after ablation were not thoroughly studied. Methods and Results— From 2009 to 2013, consecutive patients referred for post–myocardial infarction ventricular tachycardia ablation were included. The end point of the procedure was complete elimination of local abnormal ventricular activities (LAVA) and ventricular tachycardia (VT) noninducibility. The predictors of outcome with primary end point of VT recurrence were assessed. A total of 125 patients were included (age: 64±11 years; 7 women) for 142 procedures. The left ventricle was accessed via transseptal, retrograde aortic, and epicardial approaches in 87%, 33%, and 37% of patients, respectively. Three-dimensional electroanatomical mapping system was used in 70%, multipolar catheter in 51%, and real-time image integration in 38% (from magnetic resonance imaging in 39% and multidetector computed tomography in 93%) of patients. Before ablation, VT was inducible in 75%, and endocardial/epicardial LAVA were present in 88%/75%. After ablation, complete LAVA elimination was achieved in 60%, and VT noninducibility in 83%. During a median follow-up of 850 days (interquartile range, 439–1707), VT recurrence was observed in 36%. Multivariable analysis identified 3 independent outcome predictors: the ability to achieve complete LAVA elimination ( R 2 =0.29; P <0.0001; risk ratio=0.52 [0.38–0.70]), the use of real-time image integration ( R 2 =0.21; P =0.0006; risk ratio=0.49 [0.33–0.74]), and the use of multipolar catheters ( R 2 =0.08; P =0.05; risk ratio=0.75 [0.56–1.00]). Conclusions— Achievement of complete LAVA elimination and use of scar integration from imaging and multipolar catheters to focus high-density mapping are independent predictors of VT-free survival after catheter ablation for post–myocardial infarction ventricular tachycardia.

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Section: What the Study Addsmentioning

confidence: 99%

Impact of New Technologies and Approaches for Post–Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up

Yamashita

Cochet

Sacher

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…In our current study, the standard CARTO segmentation tool was used to create cardiac anatomy of all the patients to evaluate and provide a commonly available workflow. Yamashita et al described the use of high‐resolution image integration of the phrenic nerve and coronary anatomy in epicardial RF ablation procedures to minimize the risk of injuring these structures. As described in this study, right phrenic nerve segmentation can be performed using the MUSIC software.…”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures

Bourier

Vlachos

Lam

et al. 2019

Cardiovasc electrophysiol

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Background We present a new, easily applicable approach for the guidance of cryoballoon (CB) pulmonary vein isolation (PVI) procedures that use the combination of a 3D‐mapping system image integration module and computed tomographic (CT)–derived anatomy. The aim of this retrospective, nonrandomized study was to investigate: (a) an alternative use for an established radiofrequency image integration module for cryo procedures; (b) a guidance technology for cryo PVI based on integrated CT anatomy; and (c) its clinical impact. Methods and results CT left atrium–angiography was performed in 50 consecutive patients before a CB PVI procedure, and a 3D reconstruction of the cardiac anatomy was segmented. A total of 25 patients were treated using conventional fluoroscopy; 25 patients were treated using the 3D image integration technique. In the image integration group, the CARTO3 UNIVU (Biosense Webster) module was used for image integration of 3D anatomy and fluoroscopic imaging. Transseptal puncture and cryo PVI were guided by 3D‐overlay imaging. Procedures were feasible without complications in all patients and cryo PVI procedures were successfully guided using the image integration technique. The intraprocedural time needed to perform image integration was 37 ± 10 seconds. Fluoroscopy time was 31.7 ± 11.7 minutes in the conventional group and 20.1 ± 7.9 minutes in the image integration group (P < .001), procedure time was 116.3 ± 29.0 minutes in the conventional group vs 101.2 ± 20.9 minutes in the 3D group (P = .04). Conclusion 3D‐overlay guidance of CB PVI is feasible, safe, and applicable in real time with minimal effort. It may significantly reduce radiation exposure by introducing 3D information, known from electroanatomic mapping systems, into cryo PVI procedures.

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“…Image integration can also provide important information regarding structures adjacent to the LA, particularly the esophagus allowing possible energy titration during ablation and mapping/isolation of the CS . Recently, even the reconstruction of the phrenic nerve has been reported possibly reducing the risk of hemidiaphragmatic paralysis . Reconstruction of the coronary arteries as well as the epicardial fat provides direct feedback for possible epicardial approaches of AF ablation…”

Section: Discussionmentioning

confidence: 99%

Validation of a novel CARTOSEG™ segmentation module software for contrast‐enhanced computed tomography‐guided radiofrequency ablation in patients with atrial fibrillation

Imanli¹,

Bhatty²,

Jeudy³

et al. 2017

Pacing Clinical Electrophis

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Role of High-Resolution Image Integration to Visualize Left Phrenic Nerve and Coronary Arteries During Epicardial Ventricular Tachycardia Ablation

Cited by 59 publications

References 31 publications

Impact of New Technologies and Approaches for Post–Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up

Impact of New Technologies and Approaches for Post–Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up

Three‐dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures

Validation of a novel CARTOSEG™ segmentation module software for contrast‐enhanced computed tomography‐guided radiofrequency ablation in patients with atrial fibrillation

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