Imaging techniques in cardiac electrophysiology

Abstract

Modern cardiac electrophysiology procedures include catheter-based arrhythmia ablation and transvenous device implantation, which are highly dependent on accurate, real-time cardiac imaging. With the realization that anatomic structures are critical to successful electrophysiologic procedures, accurately defining a patient's cardiac anatomy has become more important. Fluoroscopy allows for 2D imaging of cardiac structures in real-time, and is used to guide catheter and lead placement, but does not allow for visualization of soft tissues. Intracardiac echocardiography allows for both direct visualization of anatomic structures within the heart and real-time imaging during catheter placement. Despite advances in intracardiac echocardiography catheters that allow for larger windows, the ability to accurately delineate anatomic structures depends on the patient's anatomy and operator experience. Neither of these techniques allows for electrical mapping of the heart; however, both anatomic and electrical intracardiac mapping can be achieved with advanced mapping systems. These systems allow for real-time catheter localization, help elucidate cardiac anatomy, evaluate electrical activation during arrhythmias and guide catheter placement for deliverance of radiofrequency current. More recently, 3D cardiac computed tomography has been used to accurately define intracardiac anatomy; however, catheter tracking and electrical mapping cannot be performed by computed tomography. Mapping systems are now being merged with computed tomography images to produce an accurate anatomic and electrical map of the heart to guide catheter ablations. The objective of this paper is to describe the current imaging and mapping techniques used in electrophysiologic procedures.

Cardiac Electrophysiology Studies Based on Image and Machine Learning

“…But to develop cost-effective real-time assessment techniques to diagnose the cardio electrophysiology pathologies can assist in disseminating the error-free information of the affected area of the patient for the further treatment procedure. Modern cardiac electrophysiology studies include catheter-based arrhythmia ablation and transvenous device implantation, which are highly dependent on accurate, real-time cardiac imaging and machine learning [4]. This era has been led to an explosion of advance technology especially machine learning.…”

Intracardiac echocardiographic thrombus detection just before transseptal puncture

“…Intracardiac echo has been widely used in order to increase safety in electrophysiological procedures, 6,7 and particularly in atrial fibrillation ablation. [8][9][10] The image below refers to an intracardiac echo-guided transseptal puncture during ablation of persistent atrial fibrillation.…”

Three‐dimensional imaging is here and now: Time to prove its relevance

“…Most cardiologists involved in the new imaging technologies believe that patient benefits are real. Electrophysiologists are using three‐dimensional visualization aid in ablative complex catheter based procedures by projecting real‐time catheter positions onto to static three‐dimensional images obtained pre‐procedure [2, 3].…”