The Impact of CT Image Integration into an Electroanatomic Mapping System on Clinical Outcomes of Catheter Ablation of Atrial Fibrillation

Kistler, Peter M.; Rajappan, Kim; Jahngir, Mohammed; Earley, Mark J.; Harris, Simon; Abrams, Dominic J.; Gupta, Dhiraj; Liew, Reginald; Ellis, Stephen; Sporton, Simon; Schilling, Richard J.

doi:10.1111/j.1540-8167.2006.00594.x

Cited by 235 publications

(143 citation statements)

References 38 publications

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“…737,738 Another approach involves use of 3D rotational angiography images that can be merged with live two-dimensional fluoroscopy. 739 This approach is rarely used at the present time.…”

Section: Section 6: Technology and Toolsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,763

1,468

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“…737,738 Another approach involves use of 3D rotational angiography images that can be merged with live two-dimensional fluoroscopy. 739 This approach is rarely used at the present time.…”

Section: Section 6: Technology and Toolsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,763

1,468

View full text Add to dashboard Cite

“…The surface reconstruction of the RA with superior vena cava, left atrium, PVs, RV, and LV were segmented from each chamber volume through a 3-step process as described previously. [1][2][3][4][5]7,8 Individual implanted clips within each chamber were also segmented to serve as specific, predetermined 3D CT anatomic fiducial points.…”

Section: Ct Imaging and Image Segmentationmentioning

confidence: 99%

“…Electroanatomic or impedance-based mapping systems merge preacquired, segmented computed tomographic (CT)/magnetic resonance imaging volume data sets and accompanying multidimensional maps by matching specific anatomic fiducial points seen on both anatomic and physiological renderings and simultaneously displaying them within the same coordinate system. [1][2][3][4][5][6][7][8] Although displaying an ablation catheter and integrating its position within CT/magnetic resonance geometry is possible, the accuracy of the integrated 3D geometry is highly dependent on image quality and, more importantly, on the merge process. [1][2][3][4][5][6][7][8] Errors may stem from changes in cardiac chamber volume or rhythm occurring between the time of 3D anatomic image acquisition and electroanatomic mapping in the electrophysiology laboratory.…”

mentioning

confidence: 99%

Three-Dimensional Ultrasound for Image-Guided Mapping and Intervention

Okumura¹,

Henz²,

Johnson³

et al. 2008

Circ: Arrhythmia and Electrophysiology

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Background-Multiple factors create discrepancies between electroanatomic maps and merged, preacquired computed tomographic images used in guiding atrial fibrillation ablation. Therefore, a Carto-based 3D ultrasound image system (Biosense Webster Inc) was validated in an animal model and tested in 15 atrial fibrillation patients. Methods and Results-Twelve dogs underwent evaluation using a newly developed Carto-based 3D ultrasound system.After fiducial clip markers were percutaneously implanted at critical locations in each cardiac chamber, 3D ultrasound geometries, derived from a family of 2D intracardiac echocardiographic images, were constructed. Point-source error of 3D ultrasound-derived geometries, assessed by actual real-time 2D intracardiac echocardiographic clip sites, was 2.1Ϯ1.1 mm for atrial and 2.4Ϯ1.2 mm for ventricular sites. These errors were significantly less than the variance on CartoMerge computed tomographic images (atria: 3.3Ϯ1.6 mm; ventricles: 4.8Ϯ2.0 mm; PϽ0.001 for both). Target ablation at each clip, guided only by 3D ultrasound-derived geometry, resulted in lesions within 1.1Ϯ1.1 mm of the actual clips. Pulmonary vein ablation guided by 3D ultrasound-derived geometry resulted in circumferential ablative lesions. Mapping in 15 patients produced modestly smaller 3D ultrasound versus electroanatomic map left atrial volumes (98Ϯ24 cm 3 versus 109Ϯ25 cm 3 , PϽ0.05). Three-dimensional ultrasound-guided pulmonary vein isolation and linear ablation in these patients were successfully performed with confirmation of pulmonary vein entrance/exit block.Conclusions-These data demonstrate that 3D ultrasound images seamlessly yield anatomically accurate chamber geometries. Image volumes from the ultrasound system are more accurate than possible with CartoMerge computed tomographic imaging. This clinical study also demonstrates the initial feasibility of this guidance system for ablation in patients with atrial fibrillation. (Circ Arrhythmia Electrophysiol. 2008;1:110-119.)

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“…37 The advantage of the CartoMerge system was also reported by Kistler et al, with improved visualization of the complex LA geometry. 38 In a prospective randomized study, Della Bella et al further demonstrated the superior efficacy and long-term outcome of image-integration-guided ablation of AF over conventional fluoroscopicguided ablation. 39 Moreover, the integration also shortened fluoroscopy time, reduced the arrhythmia recurrence and increased the rate of restoration to sinus rhythm.…”

Section: Anatomical Identification and Integration Of Non-invasive Immentioning

confidence: 99%

Three-Dimensional Electroanatomic Mapping Systems in Catheter Ablation of Atrial Fibrillation

Chen

2010

Circ J

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Atrial fibrillation (AF) is the most common tachyarrhythmia, with a prevalence of 5% in people over the age of 65. Catheter ablation of AF has emerged as an important management choice for drug-refractory symptomatic paroxysmal or persistent AF. Three-dimensional (3D) electroanatomic mapping systems were introduced into catheter ablation of AF more than a decade ago. The 3D tool has the benefit of reducing the radiation exposure time, as well as voltage and fractionation mapping in order to identify the critical substrate during the ablation, prevent the formation of gaps, guide the ablation of post-ablation atrial tachycardia or flutter, and integrate images to improve the safety and long-term success rate. The 3D systems successfully enable safe and tailored radiofrequency ablation of AF in individual patients. (Circ J 2010; 74: 18 - 23)

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The Impact of CT Image Integration into an Electroanatomic Mapping System on Clinical Outcomes of Catheter Ablation of Atrial Fibrillation

Abstract: CA for AF guided by CT integration was associated with reduced fluoroscopy times, arrhythmia recurrence, and increased restoration of sinus rhythm. Improved visualization of complex LA geometries might improve the safety and success of CA for AF.

Cited by 235 publications

References 38 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Three-Dimensional Ultrasound for Image-Guided Mapping and Intervention

Three-Dimensional Electroanatomic Mapping Systems in Catheter Ablation of Atrial Fibrillation

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