Three-dimensional left atrial and esophagus reconstruction using cardiac C-arm computed tomography with image integration into fluoroscopic views for ablation of atrial fibrillation: Accuracy of a novel modality in comparison with multislice computed tomography

Nölker, Georg; Gutleben, Klaus; Marschang, Harald; Ritscher, Guido; Asbach, Stefan; Marrouche, Nassir F.; Brachmann, Johannes; Sinha, Anil M.

doi:10.1016/j.hrthm.2008.09.011

Cited by 65 publications

(47 citation statements)

References 18 publications

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“…Different protocols of this technique have been introduced over time [14][15][16][17][18][19] having in common the principle of a C-arm run around the patients` region of interest (in case of AF ablation the LA) with acquisition of X-ray images with a certain rate of frames per second using a flat panel detector (see Figure 1). To enhance cardiac structures, contrast media is administered into the right atrium or the pulmonary artery and C-arm run is started after a delay reflecting the pulmonary transition time.…”

Section: Principles Of Rotational Angiographymentioning

confidence: 99%

“…Two studies have compared accuracy of MSCT with rotational angiography. In our study, 16 planes from pre-procedural MSCT and DynaCT Cardiac (Siemens AG, Forchheim, Germany) were automatically parallelised and cross-sectional diameters of PVs, LA appendage and LA and aorta were correlated. In our series we found an overall correlation of diameter of 0.99 and no significant difference in diameters derived from rotational angiography and MSCT.…”

Section: Principles Of Rotational Angiographymentioning

confidence: 99%

“…As image acquisition by rotational angiography is performed with the patient at the same place where ablation is done, no registration or adjustment of the reconstruction is needed as long as the patient does not move. 16 In case of need for registration due to movements, protocols have been introduced to facilitate this based on the position of the LA related to the spinal column and the trachea and mainstem bronchi. 21 A limitation of the overlay technology still is the missing compensation for respiration.…”

Section: Three-dimensional Reconstructions Of Rotational Angiography mentioning

confidence: 99%

See 2 more Smart Citations

The Role of Three-dimensional Rotational Angiography in Atrial Fibrillation Ablation

Nölker

Horstkotte

Gutleben

2013

Arrhythmia &Amp; Electrophysiology Review

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Catheter ablation is an established treatment option for patients with symptomatic atrial fibrillation (AF).1-3 Pulmonary vein (PV) angiography has been the initial imaging tool in AF ablation and is still used by up to 50 % of leading electrophysiologists.3 PV angiography still plays a major role in balloon-based ablation techniques routinely performed without electroanatomical mapping (EAM). Some very experienced centres do not feel any need for three-dimensional (3D) imaging due to their ability to orientate in two-dimensional (2D) fluoroscopic views.3D imaging is likely to better reflect relations between anatomic structures and ensures that all PVs are clearly identified. Therefore, it is not surprising that the majority of studies done on image integration of 3D shells into EAM show positive effects on radiation exposure, procedural and long-term success. [4][5][6] In particular, results of large multicentre registries clearly show the benefit of image integration regarding freedom from AF 7 in comparison with fluoroscopy-guided ablation. Integration of 3D reconstructions of pre-procedurally acquired data sets derived from multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) into EAM systems has been introduced to guide left atrial (LA) ablation procedures. [8][9][10][11][12][13] However, these remote imaging technologies may not perfectly reflect the status found during ablation due to changes in cardiac rhythm and preload, and their impact on the LA volume for example. Therefore, the search for an intra-procedural technology close to realtime imaging continued and led to the development of rotational angiography. Principles of Rotational AngiographyDifferent protocols of this technique have been introduced over time [14][15][16][17][18][19] having in common the principle of a C-arm run around the patients` region of interest (in case of AF ablation the LA) with acquisition of X-ray images with a certain rate of frames per second using a flat panel detector (see Figure 1). To enhance cardiac structures, contrast media is administered into the right atrium or the pulmonary artery and C-arm run is started after a delay reflecting the pulmonary transition time. Individual pulmonary transition time can be estimated by a bolus injection of contrast media into the pulmonary artery. This compensates for delayed enhancements due to low cardiac output. Alternatively, direct injection into the LA is performed and the C-arm run is started with a short delay. A more intense contrast of the LA may be seen after direct injection. However, contrast injection into the LA may lead to an artificial enlargement of its image. For enhancement of the oesophagus the patient is asked to swallow contrast paste. All these approaches provide data sets that allow for measurements in virtually unlimited planes and 3D reconstruction of the LA, PV, aorta and the oesophagus applying software on different specialised computer systems (e.g. Syngo X-Workplace, Siemens, Forchheim, Germany and EP Navigator, Philips, Best...

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Section: Principles Of Rotational Angiographymentioning

confidence: 99%

Section: Principles Of Rotational Angiographymentioning

confidence: 99%

Section: Three-dimensional Reconstructions Of Rotational Angiography mentioning

confidence: 99%

See 1 more Smart Citation

The Role of Three-dimensional Rotational Angiography in Atrial Fibrillation Ablation

Nölker

Horstkotte

Gutleben

2013

Arrhythmia &Amp; Electrophysiology Review

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“…Because the CT-type image is acquired at the time of the procedure, it may be more likely to represent the true anatomy than a remotely acquired image. 33 Like CT, this image can be viewed or integrated into the imaging system or EAM. Unfortunately, also like CT, iodinated contrast agents and higher-radiation doses are used to generate these images.…”

Section: Rotational Angiographymentioning

confidence: 99%

New Technologies in Atrial Fibrillation Ablation

Burkhardt

Natale

2009

Circulation

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he treatment of atrial fibrillation has changed greatly in the past decade. Not long ago, the scientific community argued the benefits of a rate-control strategy versus a rhythmcontrol strategy. 1 This argument was always hampered by the relative ineffectiveness of the antiarrhythmic medications used as rhythm-control agents. Ablation therapy for the treatment of atrial fibrillation has quickly evolved. Originally, ablation was focused on finding triggers of atrial fibrillation in the pulmonary veins. 2,3 Now, ablation offers a potential curative strategy for patients with paroxysmal, persistent, or permanent atrial fibrillation. Recent data continue to show that atrial fibrillation ablation is superior to the currently available antiarrhythmic medications in the maintenance of sinus rhythm, and the Food and Drug Administration has approved devices labeled for the ablation of atrial fibrillation. 4 -6 It is estimated that Ͼ2 million people in the United States have atrial fibrillation. 7 Although the number of atrial fibrillation ablations continues to increase year after year, offering this therapy to all potential candidates is impossible because of several limitations. 8,9 A finite number of fellows are being trained in programs that offer a great deal of experience in atrial fibrillation ablation, and there is limited opportunity for practicing electrophysiologists to learn new techniques. Unlike supraventricular tachycardia ablation, atrial fibrillation ablation requires greater technical skill, significantly more lesions, and time. Like many other medical procedures, technological innovation is likely to be a contributing factor in making atrial fibrillation ablation a more commonplace and widely practiced therapy.Navigating the complex anatomy of the left atrium is also difficult to master. Imaging technologies have been used to orient the operator to the anatomy and the location of the ablation catheters in this anatomy. With fluoroscopy alone, it is difficult to determine anterior versus posterior orientation or the presence of the catheter in a pulmonary vein versus the left atrial appendage. Intracardiac echocardiography (ICE) provides 2-dimensional navigation assistance and excellent anatomic detail; however, it is difficult to locate the catheter tip at all times in the echocardiography field. Without 3-dimensional (3D) imaging, navigation with ICE alone is also difficult. Electroanatomic mapping (EAM) systems offer a 3D view and nearly real-time catheter tip localization within a created construct of the left atrium, but the data are heavily dependent on the input of the operator and cartographer. Newer technology has merged these 2 imaging modalities to offer the best of both worlds.Remotely obtained computed tomography (CT) imaging of the left atrium has been performed to define the complex anatomy of the left atrium. This can be integrated into EAMs or imaging systems to aid in navigation and procedure planning. However, conditions at the time of CT may be different from those at the time of a...

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“…In fact, state-of-the art C-arm systems [7,8], facilitate 3-D tomographic reconstruction. In other words, the fluoroscopic C-arm device itself can be used to obtain volumetric data sets, e.g., of the heart [9][10][11][12][13][14]. Since the 3-D data has been acquired on the same device that is used for 2-D X-ray imaging, initial registration of the 3-D data set to the 2-D fluoroscopic projection can be accomplished.…”

Section: Introductionmentioning

confidence: 99%

Model-Based Registration for Motion Compensation during EP Ablation Procedures

Brost

Liao

Hornegger

et al. 2010

Biomedical Image Registration

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Abstract. Radio-frequency catheter ablation (RFCA) has become an accepted treatment option for atrial fibrillation (Afib). RFCA of Afib involves isolation of the pulmonary veins under X-ray guidance. For easier navigation, two-dimensional X-ray imaging may take advantage of overlay images derived from static pre-operative 3-D data set to add anatomical details which, otherwise, would not be visible under X-ray. Unfortunately, respiratory and cardiac motion may impair the utility of static overlay images for catheter navigation. We developed a system for image-based 2-D motion estimation and compensation as a solution to this problem. It is based on 2-D catheter tracking facilitated by modelbased registration of an ellipse-shaped model to fluorosocpic images. A mono-plane or a bi-plane X-ray C-arm system can be used. In the first step of the method, a 2-D model of the catheter device is computed. Respiratory and cardiac motion at the site of ablation is then estimated by tracking the catheter device in fluoroscopic images. The cost function of the registration step is based on the average distance of the model to the segmented circumferential mapping catheter using a distance map. In our experiments, the circumferential catheter was successfully tracked in 688 fluoroscopic images with an average 2-D tracking error of 0.59 mm ± 0.25 mm. Our presented method achieves a tracking rate of 10 frames-per-second.

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Three-dimensional left atrial and esophagus reconstruction using cardiac C-arm computed tomography with image integration into fluoroscopic views for ablation of atrial fibrillation: Accuracy of a novel modality in comparison with multislice computed tomography

Cited by 65 publications

References 18 publications

The Role of Three-dimensional Rotational Angiography in Atrial Fibrillation Ablation

The Role of Three-dimensional Rotational Angiography in Atrial Fibrillation Ablation

New Technologies in Atrial Fibrillation Ablation

Model-Based Registration for Motion Compensation during EP Ablation Procedures

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