Recent trends in imaging for atrial fibrillation ablation

Rajesh Kabra, Jagmeet Singh, Rajesh Kabra, Jagmeet Singh

Abstract

Catheter ablation provides an important treatment option for patients with both paroxysmal and persistent atrial fibrillation. It mainly involves pulmonary vein isolation and additional ablations in the left atrium in persistent cases. There have been significant advancements in this procedure to enhance the safety and effectiveness. One of them is the evolution of various imaging modalities to facilitate better visualization of the complex left atrial anatomy and the pulmonary veins in order to deliver the lesions accurately. In this article, we review the electroanatomic mapping systems including the magnetic-based and impedence-based systems. Each of these mapping systems has its own advantages and disadvantages. In addition, we also discuss the role of intracardiac echocardiography and three dimensional rotational angiography in atrial fibrillation ablation.

Keywords: Atrial fibrillation; catheter ablation; imaging.

Figures

Figure 1
Figure 1
The electroanatomic map of the left atrium using CARTO (left) can be integrated with the CT/MRI images using CARTOMERGE Module (right). The arrows depict the corresponding points on the two maps.
Figure 2
Figure 2
Use of intracardiac echocardiogram to facilitate image integration by CARTO 3. Left: Posterior view of the left atrium with overlay of images acquired by intracardiac echocardiogram. Right: Left atrial image following image integration with pre-acquired MRI image.
Figure 3
Figure 3
An internal view (right lateral) of the left atrium using CARTO demonstrates the ridge between the left atrial appendage and left pulmonary veins which is a common site of pulmonary vein reconnection.
Figure 4
Figure 4
Left atrial electroanatomic map generated by Ensite NavX (Left: anterior view, Right: posterior view). Red dots represent the ablation points, while the yellow dots represent the points acquired by multielectrode mapping catheter.
Figure 5
Figure 5
Representation of the complex fractionated atrial electrograms (CFAE) using Ensite NavX automated software. Left: Anterior view of the left atrium showing predominant location of CFAEs over anterior wall and the roof. Right: Posterior view of the left atrium showing the ablation lesion sets (red dots) for pulmonary vein isolation and the left atrial posterior wall.
Figure 6
Figure 6
Activation mapping of the atrial flutter following pulmonary vein isolation using Ensite NavX. The figures (Left: posterior view of the left atrium and pulmonary veins, Right: anterior view of the left atrium) demonstrate ‘early meets late’ phenomena suggesting a macro-reentrant atrial flutter.
Figure 7
Figure 7
Reconstruction of the left atrial and pulmonary venous anatomy by 3 D rotational angiogram.

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