Three-Dimensional Image Integration: A First Experience with Guidance of Atrial Fibrillation Ablations

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial tachycardias (AT) are amongst the most frequent complications in adult patients with congenital heart disease (ACHD). Their incidence mainly depends on age and complexity of underlying defect. AT has a marked impact on morbidity and mortality and is associated with sudden cardiac death particularly in complex ACHD patients. The arrhythmic substrate can be variable from re-entry to multifocal resulting in demanding requirements for electrophysiologic ablation procedures (EP) and thus, relatively high rates of recurrence. Methods and results Retrospective analysis of ACHD patients with prior Damus-Kaye-Stansel (DKS) surgery treated at one of the largest specialized tertiary centers for ACHD patients worldwide. Analysis focussed on occurrence of AT, respective treatment and outcome of EP. Over a median observation time of 15 years, 13 patients with prior DKS surgery and complex congenital heart defects of different types but uniformly Fontan circulation, were identified (median age 22.0 years (IQR 20.5 – 25.5), 76.9% male, 92.3% NYHA Class I, median systemic ventricular ejection fraction 58.5%, 69.2% extracardiac tunnel). Seven patients (53.8%) presented with symptomatic AT (median cyclic length 440 ms (IQR 360.0 – 517.5)). Of these, six patients underwent EP. Median procedure time was 180.5 min (IQR 160.8 – 274.5), median fluoroscopy time 1.56 min (IQR 0.51 – 4.73) and radiofrequency time 851 sec (265.0 -2005.0). Remote magnetic navigation was used to access ablation site through a retrograde access via the aortic as well as the neo-aortic valve. Three-dimensional image integration aided in mapping and ablation. Throughout the procedure as well as in follow-up visits, no reportable complications were observed. After a mean of 1.5 procedures, all analysed patients stayed complaint-free throughout a median time-interval of 13 months. Conclusion AT are frequent in complex univentricular situations after Damus-Kaye-Stansel surgery (53.8%). Although more than one procedure (mean 1.5) was necessary to achieve satisfactory results even in experienced hands, EP appears to be an appropriate treatment strategy in this young and otherwise healthy patient cohort. According to our analysis, EP is feasible and safe in centers with knowledge of specific anatomic characteristics of congenital heart disease and when the appropriate technical infrastructure is present. Access to ablation site was performed by remote magnetic navigation in the majority of procedures. The floppy catheter was navigated through the neo-aortic as well as through the aortic valve without observable peri- or postinterventional complications. Mapping with three-dimensional image integration facilitated EP and led to a relatively low radiation exposure with the known benefits for the patient as well as for the healthcare professionals involved in the procedure. Abstract Figure.

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Three-dimensional left atrial and esophagus reconstruction using cardiac C-arm computed tomography with image integration into fluoroscopic views for ablation of atrial fibrillation: Accuracy of a novel modality in comparison with multislice computed tomography

Heart Rhythm ◽

10.1016/j.hrthm.2008.09.011 ◽

2008 ◽

Vol 5 (12) ◽

pp. 1651-1657 ◽

Cited By ~ 57

Author(s):

Georg Nölker ◽

Klaus Jürgen Gutleben ◽

Harald Marschang ◽

Guido Ritscher ◽

Stefan Asbach ◽

...

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Left Atrial ◽

Multislice Computed Tomography ◽

Three Dimensional ◽

Image Integration

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

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2013.2.2.120 ◽

2013 ◽

Vol 2 (2) ◽

pp. 120

Author(s):

Georg Nölker ◽

Dieter Horstkotte ◽

Klaus-Jürgen Gutleben ◽

◽

...

Keyword(s):

Atrial Fibrillation ◽

3D Imaging ◽

Imaging Techniques ◽

Pulmonary Veins ◽

Three Dimensional ◽

Current Status ◽

Rotational Angiography ◽

Image Integration ◽

Af Ablation ◽

Magnetic Resonance Imaging Mri

Three-dimensional (3D) imaging became the cornerstone of catheter guidance in atrial fibrillation (AF) ablation procedures during the last few years. Multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) have been the technologies of choice for pre-procedural imaging of the left atrium (LA) and the pulmonary veins to make lesions more precisely set in a highly variable and difficult to understand 3D environment. These technologies have been used not only for pre-procedural orientation but have also been overlayed to fluoroscopic views in many fluoroscopy-guided ablation procedures. As image integration into non-fluoroscopic 3D imaging systems became available, 3D reconstructions of MSCT and MRI became the standard approach in many centres. However, 3D imaging is not a cornerstone during ablation as it is not indispensable and ablation can be performed without. Although rare, some very important and key centres do not routinely use 3D imaging during ablation. Being remote to the ablation procedure, these imaging technologies may have the disadvantage of not reflecting the current status of a variable LA volume and scheduling of an additional diagnostic procedure may complicate the workflow of AF ablation procedures. Intra-procedural imaging techniques are likely to overcome both issues. Beside others, rotational angiography has been introduced for proving highly actual imaging by intra-procedural acquisition of 3D shells suitable for overlay to fluoroscopy without need for registration and image integration into 3D mapping systems registered by point-by-point electroanatomical mapping or 3D echocardiographic imaging.

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Criteria and Methods for Reliable Three-Dimensional Image Reconstruction

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100051669 ◽

1974 ◽

Vol 32 ◽

pp. 330-331

Author(s):

R. A. Crowther

Keyword(s):

Image Reconstruction ◽

Finite Number ◽

Density Distribution ◽

Electron Micrographs ◽

Mathematical Problem ◽

Three Dimensional ◽

Ideal Case ◽

Dimensional Image ◽

General Object ◽

The Ideal

The reconstruction of a three-dimensional image of a specimen from a set of electron micrographs reduces, under certain assumptions about the imaging process in the microscope, to the mathematical problem of reconstructing a density distribution from a set of its plane projections.In the absence of noise we can formulate a purely geometrical criterion, which, for a general object, fixes the resolution attainable from a given finite number of views in terms of the size of the object. For simplicity we take the ideal case of projections collected by a series of m equally spaced tilts about a single axis.

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