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Integration of 3-Dimensional Cardiac Computed Tomography Images With Real-Time Electroanatomic Mapping to Guide Catheter Ablation of Atrial Fibrillation

2005; Lippincott Williams & Wilkins; Volume: 112; Issue: 2 Linguagem: Inglês

10.1161/01.cir.0000161085.58945.1c

1524-4539

Brad J. Mikaelian, Zachary J. Malchano, Petr Neužil, J. Weichet, Shephal K. Doshi, Jeremy N. Ruskin, Vivek Y. Reddy,

Cardiac electrophysiology and arrhythmias

HomeCirculationVol. 112, No. 2Integration of 3-Dimensional Cardiac Computed Tomography Images With Real-Time Electroanatomic Mapping to Guide Catheter Ablation of Atrial Fibrillation Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBIntegration of 3-Dimensional Cardiac Computed Tomography Images With Real-Time Electroanatomic Mapping to Guide Catheter Ablation of Atrial Fibrillation Brad J. Mikaelian, Zachary J. Malchano, Petr Neuzil, Jiri Weichet, Shephal K. Doshi, Jeremy N. Ruskin and Vivek Y. Reddy Brad J. MikaelianBrad J. Mikaelian From the Cardiac Arrhythmia Services of Massachusetts General Hospital–Harvard Medical School (B.J.M., Z.J.M., S.K.D., J.N.R., V.Y.R.), Boston, Mass; Na Homolce Hospital (P.N., J.W.), Prague, Czech Republic; and the Department of Internal Medicine (B.J.M.), Boston Medical Center, Boston, Mass. , Zachary J. MalchanoZachary J. Malchano From the Cardiac Arrhythmia Services of Massachusetts General Hospital–Harvard Medical School (B.J.M., Z.J.M., S.K.D., J.N.R., V.Y.R.), Boston, Mass; Na Homolce Hospital (P.N., J.W.), Prague, Czech Republic; and the Department of Internal Medicine (B.J.M.), Boston Medical Center, Boston, Mass. , Petr NeuzilPetr Neuzil From the Cardiac Arrhythmia Services of Massachusetts General Hospital–Harvard Medical School (B.J.M., Z.J.M., S.K.D., J.N.R., V.Y.R.), Boston, Mass; Na Homolce Hospital (P.N., J.W.), Prague, Czech Republic; and the Department of Internal Medicine (B.J.M.), Boston Medical Center, Boston, Mass. , Jiri WeichetJiri Weichet From the Cardiac Arrhythmia Services of Massachusetts General Hospital–Harvard Medical School (B.J.M., Z.J.M., S.K.D., J.N.R., V.Y.R.), Boston, Mass; Na Homolce Hospital (P.N., J.W.), Prague, Czech Republic; and the Department of Internal Medicine (B.J.M.), Boston Medical Center, Boston, Mass. , Shephal K. DoshiShephal K. Doshi From the Cardiac Arrhythmia Services of Massachusetts General Hospital–Harvard Medical School (B.J.M., Z.J.M., S.K.D., J.N.R., V.Y.R.), Boston, Mass; Na Homolce Hospital (P.N., J.W.), Prague, Czech Republic; and the Department of Internal Medicine (B.J.M.), Boston Medical Center, Boston, Mass. , Jeremy N. RuskinJeremy N. Ruskin From the Cardiac Arrhythmia Services of Massachusetts General Hospital–Harvard Medical School (B.J.M., Z.J.M., S.K.D., J.N.R., V.Y.R.), Boston, Mass; Na Homolce Hospital (P.N., J.W.), Prague, Czech Republic; and the Department of Internal Medicine (B.J.M.), Boston Medical Center, Boston, Mass. and Vivek Y. ReddyVivek Y. Reddy From the Cardiac Arrhythmia Services of Massachusetts General Hospital–Harvard Medical School (B.J.M., Z.J.M., S.K.D., J.N.R., V.Y.R.), Boston, Mass; Na Homolce Hospital (P.N., J.W.), Prague, Czech Republic; and the Department of Internal Medicine (B.J.M.), Boston Medical Center, Boston, Mass. Originally published12 Jul 2005https://doi.org/10.1161/01.CIR.0000161085.58945.1CCirculation. 2005;112:e35–e36A 63-year-old woman was referred for catheter ablation of atrial fibrillation (AF). Two weeks before the ablation procedure, contrast-enhanced cardiac imaging was performed with a 16-slice spiral computed tomography (CT) scanner, and the planar CT images were converted to a 3D surface reconstruction of the left atrium (LA), left atrial appendage (LAA), and pulmonary veins (PVs) (Figure 1). During the electrophysiology study, a transseptal puncture was performed to enter the LA to allow mapping of the LA, LAA, and PVs with an electroanatomic mapping system (Biosense-Webster, Inc). A custom, image-guided therapy workstation was developed capable of (1) importing the 3D CT surface reconstruction, as well as electroanatomic mapping information (including real-time catheter position data) and (2) properly aligning these 2 datasets such that the catheter could be visualized and maneuvered within the high-resolution CT construct in real time to guide radiofrequency ablation (Figure 2). Accordingly, ablation lesions were placed at the periostial LA tissue to electrically isolate the PVs (Figure 3, Data Supplement Movie). Electrical isolation was confirmed by using a circular, multielectrode mapping catheter (Lasso, Biosense-Webster, Inc) for both entrance block (no electrical activity within the lesion set) and exit block (no LA capture while pacing from within the PVs). Download figureDownload PowerPointFigure 1. Three-dimensional surface reconstruction of LA PVs. Shown are posterior views of surface reconstruction of CT image (A) and corresponding view of electroanatomic geometry map (B). LIPV indicates left inferior PV; LSPV, left superior PV; RIPV, right inferior PV; and RSPV, right superior PV.Download figureDownload PowerPointFigure 2. Visualization of catheter tip within 3D CT construct. Tip of ablation catheter is visualized in real-time fashion within CT surface reconstruction: A, from external posterior view with CT construct displayed in semitransparent fashion and B, from corresponding endoscopic view of right side of LA. Ablation catheter tip (green-blue icon) is positioned touching posterior LA adjacent to ostium of right superior PV.Download figureDownload PowerPointFigure 3. Catheter ablation of periostial LA tissue to electrically isolate PVs. Final ablation lesion set is shown, both displayed on electroanatomic map (A, posterior view) and projected onto CT surface reconstruction (B, posterior view; C, left lateral view; D, right anterior oblique view). Ablation lesions (red dots) were placed in linear fashion to separately encircle and electrically isolate ipsilateral PVs. In addition, 2 linear lesions were placed: "roof line," connecting encircling lesion sets along LA roof (yellow arrows), and "mitral isthmus line," extending from encircling lesion set near left inferior PV to mitral valve annulus (blue arrows). 3D CT rendering with projected ablation lesions is rotated 360° in the accompanying Data Supplement Movie to allow for better appreciation of anatomic relationship of ablation lesions.During catheter ablation of AF, it is important to place the ablation lesions outside the PVs for both efficacy and safety reasons: to avoid leaving residual proximal cuffs of arrhythmogenic tissue and to avoid PV stenosis, respectively. Preprocedural magnetic resonance (MR) or CT imaging is often used to provide an anatomic "road map" of the LA PVs, but these static images are presently not integrated with electroanatomic mapping systems to guide the ablation procedure. This case report graphically represents the feasibility of integrating preacquired 3D CT (or MR) images with electroanatomic mapping; this image integration paradigm might improve the accuracy and safety of catheter ablation of AF.The online-only Data Supplement, which contains a movie, is available with this article at http://www.circulationaha.org.FootnotesCorrespondence to Vivek Y. Reddy, MD, Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit St, GRB 109, Boston, MA 02114. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Schwartz A, Chorin E, Mann T, M. Y, Hochstadt A, Margolis G, Viskin S, Banai S and Rosso R (2021) Reconstruction of the left atrium for atrial fibrillation ablation using the machine learning CARTO 3 m-FAM software, Journal of Interventional Cardiac Electrophysiology, 10.1007/s10840-021-01045-4, 64:1, (39-47), Online publication date: 1-Jun-2022. 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Manzke R, Reddy V, Dalal S, Hanekamp A, Rasche V and Chan R (2006) Intra-operative Volume Imaging of the Left Atrium and Pulmonary Veins with Rotational X-Ray Angiography Medical Image Computing and Computer-Assisted Intervention – MICCAI 2006, 10.1007/11866565_74, (604-611), . July 12, 2005Vol 112, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000161085.58945.1CPMID: 16009803 Originally publishedJuly 12, 2005 PDF download Advertisement SubjectsArrhythmiasCatheter Ablation and Implantable Cardioverter-DefibrillatorComputerized Tomography (CT)ElectrophysiologyImaging