Atrial fibrillation is a major cause of stroke. Its treatment is performed under fluoroscopic image guidance. Augmented fluoroscopy has become a useful tool during the ablation procedure for navigation under X-ray. Unfortunately, current navigation systems do not provide tools to localize and visualize a cryo-balloon catheters in 3-D. This is why we present a new approach to reconstruct the cryo-ballon catheter, modeled as a sphere, from two views. The reconstruction result can then be overlayed onto live fluoroscopic images during the procedure. In simulation studies, we compared our technique to a reference method. While both methods worked equally well on noise-free data, we found our method more reliable if the input data was affected by noise. For example, in the presence of noise with a standard deviation of 4 mm, our maximum 3-D reconstruction error was less than 1 mm.
The standard approach in interventional treatment of atrial fibrillation (AFib) is pulmonary vein isolation (PVI). PVI can be achieved by placing radio-frequency (RF) lesions contiguously around the pulmonary veins attached to the left atrium. Since accurate lesion placement may be difficult, pre-planned ablation lines can be used for better navigation both when using mapping systems or also when relying on fluoro overlay techniques. By working with physicians in this field, we learned that clinically acceptable ablation lines are not necessarily limited to a unique line, but there appears to be some flexibility when defining regions within which ablation should be performed.We present a novel method to investigate the dimensions of such a region based on comparing pre-planned ablation lines set up for different left atria. A common reference model is proposed as a means to combine and compare different pre-planned ablation lines. Based on our data, we found an average deviation of individually pre-planned ablation lines from their respective mean of 2.9±1.9 mm and 1.8±1.5 mm for right and left sided ipsilateral planning lines, respectively. Beyond ablation line assessment, this work also introduces a framework which can be extended to automatic pre-planning of ablation lines for PVI procedures.Index Terms-atrial fibrillation, ablation line planning, shape modeling and analysis, pulmonary vein isolation,
Abstract. Atrial fibrillation (AF), the most common arrhythmia, has been identified as a major cause of stroke. The current standard in interventional treatment of AF is the pulmonary vein isolation (PVI). PVI is guided by fluoroscopy or non-fluoroscopic electro-anatomic mapping systems (EAMS). Either classic point-to-point radio-frequency (RF) catheter ablation or so-called single-shot-devices like cryo-balloons are used to achieve electrical isolation of the pulmonary veins and the left atrium (LA). Fluoroscopy-based systems render overlay images from pre-operative 3-D data sets which are then merged with fluoroscopic imaging, thereby adding detailed 3-D information to conventional fluoroscopy. EAMS provide tracking and visualization of RF catheters by means of electro-magnetic tracking. Unfortunately, current navigation systems, fluoroscopy-based or EAMS, do not provide tools to localize and visualize single-shot-devices like cryo-balloon catheters in 3-D. We present a prototype software for fluoroscopy-guided ablation procedures that is capable of superimposing 3-D datasets as well as reconstructing cyro-balloon catheters in 3-D. The 3-D cyro-balloon reconstruction was evaluated on 9 clinical data sets, yielding a reprojected 2-D error of 1.72 mm ± 1.02 mm
Abstract. Atrial fibrillation (AFib) is the most common heart arrhythmia. In certain situations, it can result in life-threatening complications such as stroke and heart failure. For paroxsysmal AFib, pulmonary vein isolation (PVI) by catheter ablation is the recommended choice of treatment if drug therapy fails. During minimally invasive procedures, electrically active tissue around the pulmonary veins is destroyed by either applying heat or cryothermal energy to the tissue. The procedure is usually performed in electrophysiology labs under fluoroscopic guidance. Besides radio-frequency catheter ablation devices, so-called single-shot devices, e.g., the cryothermal balloon catheters, are receiving more and more interest in the electrophysiology (EP) community. Single-shot devices may be advantageous for certain cases, since they can simplify the creation of contiguous (gapless) lesion sets around the pulmonary vein which is needed to achieve PVI. In many cases, a 3-D (CT, MRI, or C-arm CT) image of a patient's left atrium is available. This data can then be used for planning purposes and for supporting catheter navigation during the procedure. Cryo-thermal balloon catheters are commercially available in two different sizes. We propose the Atrial Fibrillation Planning Tool (AFiT), which visualizes the segmented left atrium as well as multiple cryo-balloon catheters within a virtual reality, to find out how well cryo-balloons fit to the anatomy of a patient's left atrium. First evaluations have shown that AFiT helps physicians in two ways. First, they can better assess whether cryoballoon ablation or RF ablation is the treatment of choice at all. Second, they can select the proper-size cryo-balloon catheter with more confidence.Keywords: Atrial Fibrillation, Visualization, Catheter Ablation Planning, Electrophysiology, Cryo-balloon DESCRIPTION OF PURPOSEAs atrial fibrillation (AFib) is the most common heart arrhythmia [1], a lot of clinical and technical research focuses on how to improve the treatment further. In the past decade, pulmonary vein isolation (PVI) by catheter ablation has proven to be a safe and effective approach for dealing with paroxysmal AFib [2,3]. The goal of PVI is the electrical isolation of the left atrium (LA) from the pulmonary veins (PVs) to prevent propagation of electrical signals, which do not belong to the heart conduction system, from the PVs into the left atrium (LA). Isolation is achieved by creating a contiguous transmural lesions around the PVs with an ablation catheter. Besides radio-frequency (RF) catheter ablation which is currently the most common method, the use of single-shot devices is increasing. Compared to a point-by-point RF ablation strategy,
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