Validation of Three‐Dimensional Cardiac Image Integration: Use of Integrated CT Image into Electroanatomic Mapping System to Perform Catheter Ablation of Atrial Fibrillation

Kistler, Peter M.; Earley, Mark J.; Harris, Simon; Abrams, Dominic J.; Ellis, Stephen; Sporton, Simon; Schilling, Richard J.

doi:10.1111/j.1540-8167.2006.00371.x

Cited by 166 publications

(143 citation statements)

References 25 publications

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“…Manipulation of an ablation catheter in the left atrium (LA) can be time consuming and involve significant fluoroscopy, but new technologies are evolving to facilitate catheter navigation and reduce procedure and fluoroscopy times (4)(5)(6)(7). Recently, mapping systems have incorporated three-dimensional (3D) cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) imaging of the LA to facilitate nonfluoroscopic mapping (8)(9)(10)(11). These data sets can be displayed side by side with a catheter geometry, providing an anatomical reference (Digital Image Fusion ™ , EnSite 5.01 workstation, Endocardial Solutions, Inc., MN), or as an image registered with the catheter geometry (Carto XP ™ , Biosense Webster, Diamond Bar, CA and EnSite Fusion ™ , Endocardial Solutions, Inc., MN).…”

Section: Introductionmentioning

confidence: 99%

Cardiac cycle–dependent left atrial dynamics: Implications for catheter ablation of atrial fibrillation

et al. 2008

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Section: Introductionmentioning

confidence: 99%

Cardiac cycle–dependent left atrial dynamics: Implications for catheter ablation of atrial fibrillation

et al. 2008

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“…The FAM was merged with 3D-anatomical chamber reconstructions of LA and PVs derived from pre procedure (up to 24 hours) cardiac computed tomography (CT). Image integration was based on registration involving landmark points and surface alignment using the Cartomerge software (Cartomerge, Biosense Webster., Diamond Bar, CA, USA) as described previously [6]. Circular RF ablation of each vein at the antrum about 1 cm of veno-atrial junction was performed.…”

Section: Methodsmentioning

confidence: 99%

Acute and Mid-Term Results after Pulmonary Veins Isolation Using a Novel Circular Irrigated Multielectrode Mapping and Ablation Catheter (nMARQ)

Marai¹,

Suleiman²,

Lessick³

et al. 2016

WJCD

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Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation in both paroxysmal and persistent AF. However, this procedure is still challenging and time consuming. Objective: The aim of this study was to present our approach for PVI using a novel circular irrigated multielectrode mapping and ablation catheter (nMARQ TM ) and to present acute and mid-term results. Methods:The study included 31 consecutive patients with symptomatic AF (4 had persistent and 27 had paroxysmal AF) who underwent PVI using the nMARQ TM catheter. Circular ablation was guided by CT image integrated into fast anatomical map and by intra cardiac echo. Isolation of pulmonary veins was identified using the nMARQ TM catheter if it was possible to advance it into the veins, otherwise Lasso catheter was used. Patients were followed up to 20 months. Results: PVI was achieved in 119 (98%) out of 121 pulmonary veins identified, and final PVI was obtained in 30 (97%) out of 31 patients. Lasso catheter was needed for PVI confirmation in 16 (52%) patients. Touch up ablation using standard catheter guided by Lasso catheter was needed in 4 (13%) patients. Pericardial tamponade occurred in 1 patient who was treated with pericardiocentesis. No other major complications were detected. During follow-up (mean 15.9 ± 3.6 months, range 9 -20 months), 4 (13%) patients had recurrence of atrial tachyarrhythmia. Conclusion: PVI using the novel nMARQ TM catheter is safe with good acute and mid-term efficacy. Long term follow up trials are needed.

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“…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.…”

mentioning

confidence: 97%

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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Validation of Three‐Dimensional Cardiac Image Integration: Use of Integrated CT Image into Electroanatomic Mapping System to Perform Catheter Ablation of Atrial Fibrillation

Abstract: CT image integration into an EAM system was successfully performed in patients undergoing catheter ablation for AF. With a greater appreciation of the complex and variable nature of the PV and LA anatomy this new technology may improve the efficacy and safety of the procedure.

Cited by 166 publications

References 25 publications

Cardiac cycle–dependent left atrial dynamics: Implications for catheter ablation of atrial fibrillation

Cardiac cycle–dependent left atrial dynamics: Implications for catheter ablation of atrial fibrillation

Acute and Mid-Term Results after Pulmonary Veins Isolation Using a Novel Circular Irrigated Multielectrode Mapping and Ablation Catheter (nMARQ)

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

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