From 3D to 4D imaging: is that useful for interventional cardiac electrophysiology?

Abstract

Three-dimensional electroanatomical imaging is increasingly used in interventional cardiac electrophysiology, to guide catheter ablation of cardiac arrhythmias. At the same time, there is a growing interest for non-invasive methods, such as magnetocardiographic mapping (MCG), to localize the arrhythmogenic substrates, to test their reproducibility and to plan the most appropriate interventional approach. So far electroanatomical imaging has relayed on static mathematical modeling of the heart and more recently on direct merging with three-dimensional rendering of cardiac anatomy from multidetector computer tomography or magnetic resonance imaging. Merging electrophysiological information with static anatomical structures, can surely be a source of uncertainty for MCG-based pre-interventional localization of the arrhythmogenic substrate and causes mismatch between the real-time imaging of moving catheters and the static geometry of the cardiac chambers reconstructed with invasive electroanatomical imaging. The implementation of recent realistic numerical models of the beating heart in a breathing thorax can improve accuracy and fill the gap between non-invasive and interventional electroanatomical imaging.

Ablation of Atrial Fibrillation Using Novel 4-Dimensional Catheter Tracking Within Autoregistered Left Atrial Angiograms

“…The MGT adds information of primary and secondary organ motion to established methods of 3D catheter localization (4-dimensional [4D] catheter tracking). 2 As a further unique characteristic, it is coregistered with x-ray cine loops, allowing catheter tracking within dynamic cardiac chamber models. 3 We report the first clinical experience with this tracking technology for catheter ablation of AF.…”

Clinical magnetocardiography: the unshielded bet—past, present, and future

“…Apart from hardware developments, for clinical applications, looking at MCG as a powerful method for contactless and radiation-free 3D and potentially 4D functional imaging of cardiac electrophysiology ( 335 ), the development of more advanced software tools to merge MCG information in real time with other non-fluoroscopic (and/or nuclear medicine) imaging techniques (e.g., MRI and/or echocardiography ( 336 ) is absolutely a primary target to focus on. Multimodal 4D integration of magnetic current density imaging could become an unrivaled method to non-invasively investigate the dynamics of arrhythmogenic mechanisms occurring into the abnormal substrates due to ischemic and non-ischemic cardiomyopathies (including some channelopathies) ( 337 ).…”

“…The usefulness of MCG for a better understanding of the arrhythmogenic mechanisms underlying the high-risk J syndromes (225, [327][328][329][330][331][332][333][334][335][336]; the identification of atrial arrhythmogenic vulnerability (248), of left atrial dysfunction (330), and of the atrial propagation pathways (228); and the dominant frequencies (181,183,189,232) in patients with atrial fibrillation, as well as providing accurate pre-interventional 3D localization of arrhythmogenic substrates (128,193,247,249,331), has been widely reported. However, the lack of a clinical breakthrough at scale is evident.…”

Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter?

“…Jude Medical, St. Paul, MN, USA) was introduced and became a standard in the present institution. By electromagnetic sensor-embedded catheter tracking in prerecorded fluoroscopy loops, the system allows additional X-ray imaging information as well as integration of a PV angiography [16]. Working in combination with EnSite ® , it represents a combination of magnetic and impedance based tools that had been available for years before the introduction of EnSite Precision ® in 2016 ( Fig.…”