Left atrial model reconstruction in atrial fibrillation ablation: reliability of new mapping and complex impedance systems

Autor: Claudia Licciardello, Federico Calore, Sabrina Ferrara, Aldo Bonso, Giovanna Scalchi, Stefano Indiani, M. Fantinel
Rok vydání: 2016
Předmět:
Male
Patient-Specific Modeling
medicine.medical_specialty
medicine.medical_treatment
Clinical Decision-Making
Left atrium
Action Potentials
Computed tomography
Catheter ablation
030204 cardiovascular system & hematology
Multimodal Imaging
03 medical and health sciences
Imaging
Three-Dimensional
0302 clinical medicine
Heart Rate
Predictive Value of Tests
Physiology (medical)
Atrial Fibrillation
medicine
Medical imaging
Humans
Heart Atria
030212 general & internal medicine
Aged
medicine.diagnostic_test
business.industry
Models
Cardiovascular
Reproducibility of Results
Signal Processing
Computer-Assisted
Magnetic resonance imaging
Atrial fibrillation
Middle Aged
medicine.disease
Ablation
Magnetic Resonance Imaging
Surgery
Catheter
medicine.anatomical_structure
Pulmonary Veins
Catheter Ablation
Radiographic Image Interpretation
Computer-Assisted
Female
Electrophysiologic Techniques
Cardiac
Tomography
X-Ray Computed
Cardiology and Cardiovascular Medicine
business
Nuclear medicine
Zdroj: EP Europace. 19:1804-1809
ISSN: 1532-2092
1099-5129
Popis: Aims The effectiveness of atrial fibrillation (AF) ablation relies on detailed knowledge of the anatomy of the left atrium (LA) and pulmonary veins (PVs). It is common to combine computed tomography/magnetic resonance (CT/MR) with imaging by electroanatomical (EA) mapping systems. The aim of this study was to evaluate the accuracy of LA anatomical reconstruction by ‘One Model’ and ‘VeriSense’ tools (Ensite Velocity 3.0, St Jude Medical), compared with CT/MR imaging. Methods and results Seventy-two patients with AF underwent pre-procedural imaging (97% CT-scan, 3% MR imaging) and transcatheter ablation of PVs. Operators were blinded to CT/MR imaging. Electrical Coupling Index (ECI) was used to recognize venous structures when the circular catheter could not. The LA ‘One Model’ map was obtained without complications; all 124 main left PVs and 144 main right PVs were detected. Nine of 9 intermediate right PVs and 30 of 30 early branches were detected, whereas 1 of the 27 early branches on the right inferior PVs was missed. Comparison between LA intervein distances measured on the roof (RO) and the posterior wall (PW) showed a high correspondence between the EA model and CT/MR imaging (RO CT/MR imaging vs. EA: 32 ± 7 vs. 32 ± 7 mm; PW CT/MR imaging vs. EA: 36 ± 6 vs. 36 ± 7 mm). The EA model yielded slightly larger PV ostia diameters, owing to the distortion caused by catheter pressure. Conclusions Recent 3D mapping tools allow outstanding anatomical rendering and are key in complex ablation procedure set-up. This study shows that 3D anatomical reconstruction of LA, PVs, and their variable branches is not only safe and fast but also accurate and reliable.
Databáze: OpenAIRE
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