Segmentation and registration of three-dimensional rotational angiogram on live fluoroscopy to guide atrial fibrillation ablation: A new online imaging tool

Li, Jonathan H.; Haim, Moti; Movassaghi, Babak; Mendel, Jeffrey B.; Chaudhry, Ghulam M.; Haffajee, Charles I.; Orlov, Michael V.

doi:10.1016/j.hrthm.2008.10.038

Cited by 68 publications

(49 citation statements)

References 26 publications

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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%

“…Radiation exposure has been reported to be 2.2 ± 0.2 to 6.6 ± 1.8 millisievert (mSv) based on estimations from the dose-area product. 18,20,25 The huge variety of values may be traced back to different ways of estimation applied and to the different protocols used for image acquisition. However, comparisons to MSCT by some groups 18,20 showed a significantly lower effective radiation dose in rotational angiography compared with MSCT.…”

Section: Radiation Exposure By Rotational Angiographymentioning

confidence: 99%

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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%

Section: Radiation Exposure By 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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“…2. The trachea has been added to facilitate carina-based registration of the 3D model overlay to the live fluoroscopic projections during intervention [8]. The LAPV part represents the endocardial surface of the LA and the surface of the four main PV trunks.…”

Section: Model Based Segmentationmentioning

confidence: 99%

Limited Angle C-Arm Tomography and Segmentation for Guidance of Atrial Fibrillation Ablation Procedures

Schäfer

Meyer

Bullens

et al. 2012

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2012

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Abstract. Angiographic projections of the left atrium (LA) and the pulmonary veins (PV) acquired with a rotational C-arm system are used for 3D image reconstruction and subsequent automatic segmentation of the LA and PV to be used as roadmap in fluoroscopy guided LA ablation procedures. Acquisition of projections at high oblique angulations may be problematic due to increased collision danger of the detector with the right shoulder of the patient. We investigate the accuracy of image reconstruction and model based roadmap segmentation using limited angle C-arm tomography. The reduction of the angular range from 200• to 150• leads only to a moderate increase of the segmentation error from 1.5 mm to 2.0 mm if matched conditions are used in the segmentation, i.e. the model based segmentation is trained on images reconstructed with the same angular range as the test images. The minor decrease in accuracy may be outweighed by clinical workflow improvement, gained when large C-arm angulations can be avoided.

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“…In the case of pulmonary artery injection, a timing bolus is performed to determine how long until the left atrium fills and how long it stays opacified to determine the optimal timing of image acquisition. These images are processed by software to produce 3D CT-quality images that can be used during the same procedure 31,32 (Figure 2). Because the CT-type image is acquired at the time of the procedure, it may be more likely to represent the true anatomy than a remotely acquired image.…”

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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Segmentation and registration of three-dimensional rotational angiogram on live fluoroscopy to guide atrial fibrillation ablation: A new online imaging tool

Cited by 68 publications

References 26 publications

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

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

Limited Angle C-Arm Tomography and Segmentation for Guidance of Atrial Fibrillation Ablation Procedures

New Technologies in Atrial Fibrillation Ablation

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