Intraprocedural Volume Imaging of the Left Atrium and Pulmonary Veins with Rotational X‐Ray Angiography: Implications for Catheter Ablation of Atrial Fibrillation

Thiagalingam, Aravinda; Manzke, Robert; d’Ávila, André; Ho, Ivan; Locke, Andrew H.; Ruskin, Jeremy N.; Chan, Raymond C. K.; Reddy, Vivek Y.

doi:10.1111/j.1540-8167.2007.01013.x

Cited by 82 publications

(48 citation statements)

References 17 publications

(18 reference statements)

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“…Different protocols of this technique have been introduced over time [14][15][16][17][18][19] having in common the principle of a C-arm run around the patients` region of interest (in case of AF ablation the LA) with acquisition of X-ray images with a certain rate of frames per second using a flat panel detector (see Figure 1). To enhance cardiac structures, contrast media is administered into the right atrium or the pulmonary artery and C-arm run is started after a delay reflecting the pulmonary transition time.…”

Section: Principles Of Rotational Angiographymentioning

confidence: 99%

The Role of Three-dimensional Rotational Angiography in Atrial Fibrillation Ablation

Nölker

Horstkotte

Gutleben

2013

Arrhythmia &Amp; Electrophysiology Review

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Catheter ablation is an established treatment option for patients with symptomatic atrial fibrillation (AF).1-3 Pulmonary vein (PV) angiography has been the initial imaging tool in AF ablation and is still used by up to 50 % of leading electrophysiologists.3 PV angiography still plays a major role in balloon-based ablation techniques routinely performed without electroanatomical mapping (EAM). Some very experienced centres do not feel any need for three-dimensional (3D) imaging due to their ability to orientate in two-dimensional (2D) fluoroscopic views.3D imaging is likely to better reflect relations between anatomic structures and ensures that all PVs are clearly identified. Therefore, it is not surprising that the majority of studies done on image integration of 3D shells into EAM show positive effects on radiation exposure, procedural and long-term success. [4][5][6] In particular, results of large multicentre registries clearly show the benefit of image integration regarding freedom from AF 7 in comparison with fluoroscopy-guided ablation. Integration of 3D reconstructions of pre-procedurally acquired data sets derived from multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) into EAM systems has been introduced to guide left atrial (LA) ablation procedures. [8][9][10][11][12][13] However, these remote imaging technologies may not perfectly reflect the status found during ablation due to changes in cardiac rhythm and preload, and their impact on the LA volume for example. Therefore, the search for an intra-procedural technology close to realtime imaging continued and led to the development of rotational angiography. Principles of Rotational AngiographyDifferent protocols of this technique have been introduced over time [14][15][16][17][18][19] having in common the principle of a C-arm run around the patients` region of interest (in case of AF ablation the LA) with acquisition of X-ray images with a certain rate of frames per second using a flat panel detector (see Figure 1). To enhance cardiac structures, contrast media is administered into the right atrium or the pulmonary artery and C-arm run is started after a delay reflecting the pulmonary transition time. Individual pulmonary transition time can be estimated by a bolus injection of contrast media into the pulmonary artery. This compensates for delayed enhancements due to low cardiac output. Alternatively, direct injection into the LA is performed and the C-arm run is started with a short delay. A more intense contrast of the LA may be seen after direct injection. However, contrast injection into the LA may lead to an artificial enlargement of its image. For enhancement of the oesophagus the patient is asked to swallow contrast paste. All these approaches provide data sets that allow for measurements in virtually unlimited planes and 3D reconstruction of the LA, PV, aorta and the oesophagus applying software on different specialised computer systems (e.g. Syngo X-Workplace, Siemens, Forchheim, Germany and EP Navigator, Philips, Best...

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Section: Principles Of Rotational Angiographymentioning

confidence: 99%

The Role of Three-dimensional Rotational Angiography in Atrial Fibrillation Ablation

Nölker

Horstkotte

Gutleben

2013

Arrhythmia &Amp; Electrophysiology Review

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“…Intra-procedural imaging of the LAPV with 3-D RA has been described in [9,10]. Data acquisition was performed on 33 patients with the Philips Allura XPer FD10 flat detector single-plane X-ray system.…”

Section: Intra-procedural Rotational X-ray Imagingmentioning

confidence: 99%

“…A distinct drawback is the rare availability of CT or MR in the intervention room. When using pre-procedural CT or MR images instead, LAPV anatomy may vary considerably between imaging and intervention [9]. To address these issues, intra-procedural volume imaging for interrogating cardiac anatomy in 3-D has been developed and validated, using contrast-enhanced 3-D rotational X-ray angiography (3-D RA) [9,10,11] for near real-time imaging that integrates seamlessly into the current EP workflow.…”

Section: Introductionmentioning

confidence: 99%

Automatic Intra-operative Generation of Geometric Left Atrium/Pulmonary Vein Models from Rotational X-Ray Angiography

Meyer

Manzke

Peters

et al. 2008

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2008

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Abstract. Pre-procedural imaging with cardiac CT or MR has become popular for guiding complex electrophysiology procedures such as those used for atrial fibrillation ablation therapy. Electroanatomical mapping and ablation within the left atrium and pulmonary veins (LAPV) is facilitated using such data, however the pre-procedural anatomy can be quite different from that at the time of intervention. Recently, a method for intra-procedural LAPV imaging has been developed based on contrastenhanced 3-D rotational X-ray angiography (3-D RA). These intraprocedural data now create a compelling need for rapid and automated extraction of the LAPV geometry for catheter guidance. We present a new approach to automatic intra-procedural generation of LAPV surfaces from 3-D RA volumes. Using model-based segmentation, our technique is robust to imaging noise and artifacts typical of 3-D RA imaging, strongly minimizes the user interaction time required for segmentation, and eliminates inter-subject variability. Our findings in 33 patients indicate that intra-procedural LAPV surface models accurately represent the anatomy at the time of intervention and are comparable to preprocedural models derived from CTA or MRA.

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“…To update the geometry, the image must be fully reacquired. 34 One of the limitations of rotational angiography has been the speed of rotation. The c arms used for image acquisition are also used in general electrophysiological procedures.…”

Section: Rotational Angiographymentioning

confidence: 99%

New Technologies in Atrial Fibrillation Ablation

Burkhardt

Natale

2009

Circulation

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he treatment of atrial fibrillation has changed greatly in the past decade. Not long ago, the scientific community argued the benefits of a rate-control strategy versus a rhythmcontrol strategy. 1 This argument was always hampered by the relative ineffectiveness of the antiarrhythmic medications used as rhythm-control agents. Ablation therapy for the treatment of atrial fibrillation has quickly evolved. Originally, ablation was focused on finding triggers of atrial fibrillation in the pulmonary veins. 2,3 Now, ablation offers a potential curative strategy for patients with paroxysmal, persistent, or permanent atrial fibrillation. Recent data continue to show that atrial fibrillation ablation is superior to the currently available antiarrhythmic medications in the maintenance of sinus rhythm, and the Food and Drug Administration has approved devices labeled for the ablation of atrial fibrillation. 4 -6 It is estimated that Ͼ2 million people in the United States have atrial fibrillation. 7 Although the number of atrial fibrillation ablations continues to increase year after year, offering this therapy to all potential candidates is impossible because of several limitations. 8,9 A finite number of fellows are being trained in programs that offer a great deal of experience in atrial fibrillation ablation, and there is limited opportunity for practicing electrophysiologists to learn new techniques. Unlike supraventricular tachycardia ablation, atrial fibrillation ablation requires greater technical skill, significantly more lesions, and time. Like many other medical procedures, technological innovation is likely to be a contributing factor in making atrial fibrillation ablation a more commonplace and widely practiced therapy.Navigating the complex anatomy of the left atrium is also difficult to master. Imaging technologies have been used to orient the operator to the anatomy and the location of the ablation catheters in this anatomy. With fluoroscopy alone, it is difficult to determine anterior versus posterior orientation or the presence of the catheter in a pulmonary vein versus the left atrial appendage. Intracardiac echocardiography (ICE) provides 2-dimensional navigation assistance and excellent anatomic detail; however, it is difficult to locate the catheter tip at all times in the echocardiography field. Without 3-dimensional (3D) imaging, navigation with ICE alone is also difficult. Electroanatomic mapping (EAM) systems offer a 3D view and nearly real-time catheter tip localization within a created construct of the left atrium, but the data are heavily dependent on the input of the operator and cartographer. Newer technology has merged these 2 imaging modalities to offer the best of both worlds.Remotely obtained computed tomography (CT) imaging of the left atrium has been performed to define the complex anatomy of the left atrium. This can be integrated into EAMs or imaging systems to aid in navigation and procedure planning. However, conditions at the time of CT may be different from those at the time of a...

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Intraprocedural Volume Imaging of the Left Atrium and Pulmonary Veins with Rotational X‐Ray Angiography: Implications for Catheter Ablation of Atrial Fibrillation

Abstract: Intraprocedural contrast-enhanced rotational angiography provides volumetric 3-D images of the LA-PVs of comparable diagnostic value to dedicated preprocedural CT/MR imaging.

Cited by 82 publications

References 17 publications

The Role of Three-dimensional Rotational Angiography in Atrial Fibrillation Ablation

The Role of Three-dimensional Rotational Angiography in Atrial Fibrillation Ablation

Automatic Intra-operative Generation of Geometric Left Atrium/Pulmonary Vein Models from Rotational X-Ray Angiography

New Technologies in Atrial Fibrillation Ablation

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