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Initial Experience in the Use of Integrated Electroanatomic Mapping with Three‐Dimensional MR/CT Images to Guide Catheter Ablation of Atrial Fibrillation
Author(s) -
DONG JUN,
DICKFELD TIMM,
DALAL DARSHAN,
CHEEMA AAMIR,
VASAMREDDY CHANDRASEKHAR R.,
HENRIKSON CHARLES A.,
MARINE JOSEPH E.,
HALPERIN HENRY R.,
BERGER RONALD D.,
LIMA JOAO A.C.,
BLUEMKE DAVID A.,
CALKINS HUGH
Publication year - 2006
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2006.00425.x
Subject(s) - medicine , ablation , catheter ablation , atrial fibrillation , radiology , nuclear medicine , magnetic resonance imaging , ablation of atrial fibrillation , computed tomographic , computed tomography , cardiology
No prior studies have reported the use of integrated electroanatomic mapping with preacquired magnetic resonance/computed tomographic (MR/CT) images to guide catheter ablation of atrial fibrillation (AF) in a series of patients. Methods and Results: Sixteen consecutive patients with drug‐refractory AF underwent catheter ablation under the guidance of a three‐dimensional (3D) electroanatomic mapping system (Carto, Biosense Webster, Inc., Diamond Bar, CA, USA). Gadolinium‐enhanced MR (n = 8) or contrast‐enhanced high‐resolution CT (n = 8) imaging was performed within 1 day prior to the ablation procedures. Using a novel software package (CartoMerge, Biosense Webster, Inc.), the left atrium (LA) with pulmonary veins (PVs) was segmented and extracted for image registration. The segmented 3D MR/CT LA reconstruction was accurately registered to the real‐time mapping space with a combination of landmark registration and surface registration. The registered 3D MR/CT LA reconstruction was successfully used to guide deployment of RF applications encircling the PVs. Upon completion of the circumferential lesions around the PVs, 32% of the PVs were electrically isolated. Guided by a circular mapping catheter, the remaining PVs were disconnected from the LA using a segmental approach. The distance between the surface of the registered 3D MR/CT LA reconstruction and multiple electroanatomic map points was 3.05 ± 0.41 mm. No complications were observed. Conclusions: Three‐dimensional MR/CT images can be successfully extracted and registered to anatomically guided clinical AF ablations. The display of detailed and accurate anatomic information during the procedure enables tailored RF ablation to individual PV and LA anatomy.