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Image integration for atrial fibrillation ablation—pearls and pitfalls

2007; Elsevier BV; Volume: 4; Issue: 9 Linguagem: Inglês

10.1016/j.hrthm.2007.04.008

1556-3871

Peter M. Kistler, Richard J. Schilling, Kim Rajappan, Simon C. Sporton,

Cardiac electrophysiology and arrhythmias

Catheter ablation plays an important role in the management of patients with atrial fibrillation (AF). Although approaches vary, electrical isolation of the pulmonary veins (PVs) remains the cornerstone of most current ablation strategies. Pulmonary venous anatomy demonstrates tremendous interindividual variation (Figure 1). 1 Kato R. Lickfett L. Meininger G. Dickfeld T. Wu R. Juang G. Angkeow P. LaCorte J. Bluemke D. Berger R. Halperin H.R. Calkins H. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation. 2003; 107: 2004-2010 Crossref PubMed Scopus (428) Google Scholar A detailed representation of the left atrium (LA) provided by computed tomography (CT) or magnetic resonance imaging (MRI) may improve the safety and success of AF ablation. 2 Kistler P.M. Rajappan K. Jahngir M. Earley M.J. Harris S. Abrams D. Gupta D. Liew R. Ellis S. Sporton S.C. Schilling R.J. The impact of CT image integration into an electroanatomic mapping system on clinical outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006; 17: 1093-1101 Crossref PubMed Scopus (217) Google Scholar This is particularly important with the exponential rise in catheter ablation for AF 3 Cappato R. Calkins H. Chen S.A. Davies W. Iesaka Y. Kalman J. Kim Y.H. Klein G. Packer D. Skanes A. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005; 111: 1100-1105 Crossref PubMed Scopus (1283) Google Scholar as lower-volume centers strive to achieve the high success of leading international institutions. 4 Ouyang F. Bansch D. Ernst S. Schaumann A. Hachiya H. Chen M. Chun J. Falk P. Khanedani A. Antz M. Kuck K.H. Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-Lasso technique in paroxysmal atrial fibrillation. 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Heart Rhythm. 2005; 2: 1076-1081 Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar Although the technology is available, the accurate and time-efficient integration of the radiological image remains challenging. Image integration involves the acquisition of the cardiac image using CT or MRI. Then customized software is used to isolate the chamber of interest from the surrounding structures (segmentation). Finally, the segmented LA image is aligned with the real time electroanatomic map (registration). Each step in the process may be a source of error, which detracts from an accurate representation of the anatomy, which is needed to guide catheter manipulation. The aim of this review is to provide mechanistic and technical insights into image integration in an attempt to overcome potential pitfalls in this process and provide the most accurate representation of the patient's true anatomy for catheter ablation.