Cryo-balloon catheter position planning using AFiT

Abstract

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,

Cryo-balloon catheter localization in fluoroscopic images

“…Pulmonary vein isolation by minimally invasive catheter ablation has become an effective treatment approach for paroxysmal atrial fibrillation [4]. The standard technique electrically isolates the pulmonary veins with a radio-frequency ablation catheter [5]. With these catheters a point-by-point ablation is required.…”