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
References
- Wood MA, et al. A comparison of pulmonary vein ostial anatomy by computerized tomography, echocardiography, and venography in patients with atrial fibrillation having radiofrequency catheter ablation. Am J Cardiol. 2004;93:49.
- Mansour M, et al. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15:387.
- Kato R, et al. Pulmonary vein anatomy in patients undergoing catheter ablation for atrial fibrillation. Circulation. 2003;107:2004.
- Wongcharoen W, et al. Morphologic characteristics of the left atrial appendage, roof and septum: implications for the ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17:951.
- Donaldson DM, et al. Relevance of imaging structures adjacent to the left atrium during catheter ablation for atrial fibrillation. Heart Rhythm. 2010;7:269.
- Gepstein L, et al. A Novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. Circulation. 1997;95:1611.
- Kistler PM, et al. Validation of three-dimensional cardiac image integration: use of integrated CT image into electroanatomic mapping system to perform catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17:341.
- Bertaglia E, et al. Integration of three-dimensional left atrial magnetic resonance images into a real-time electroanatomic mapping system: validation of a registration method. Pacing Clin Electrophysiol. 2008;31:273.
- Piorkowshi C, et al. Electroanatomic reconstruction of the left atrium, pulmonary veins, and esophagus compared with the 'true anatomy' on multislice computed tomography in patients undergoing catheter ablation of atrial fibrillation. Heart Rhythm. 2006;3:317.
- Bella PD, et al. Image Integration-Guided Catheter Ablation of Atrial Fibrillation: A Prospective Randomized study. J Cardiovasc Electrophysiol. 2008;20:258.
- Noseworthy PA, et al. The impact of respiration on left atrial and pulmonary venous anatomy: implications for image-guided intervention. Heart Rhythm. 2005;2:1173.
- Okumura Y, et al. Three-dimensional ultrasound for image-guided mapping and intervention: methods, quantitative validation and clinical feasibility of a novel multi-modality image mapping system. Circ Arrhythm Electrophysiol. 2008;1:110.
- Uijl DW, et al. Real-time integration of intracardiac echocardiography and multislice computed tomography to guide radiofrequency catheter ablation for atrial fibrillation. Heart Rhythm. 2008;5:1403.
- Singh SM. Image integration using intracardiac ultrasound to guide catheter ablation of atrial fibrillation. Heart Rhythm. 2008;5:1548.
- Wittkampf FH, et al. LocaLisa: new technique for real-time 3-dimenstional localization of regular intracardiac electrodes. Circulation. 1999;99:1312.
- Estner HL, et al. Electrical isolation of pulmonary veins in patients with atrial fibrillation: reduction of fluoroscopy exposure and procedure duration by the use of a non-fluoroscopic navigation system (NavX) Europace. 2006;8:583.
- Brooks AG, et al. Image integration using NavX fusion: initial experience and validation. Heart Rhythm. 2008;5:526.
- Pandian NG, et al. Real-time intravascular ultrasound imaging in humans. Am J Cardiol. 1990;65:1392.
- Packer DL, et al. Intracardiac phased-array imaging: methods and initial clinical experience with high resolution, under blood visualization-initial experience with intracardiac phased-array ultrasound. J Am Coll Cardiol. 2002;39:509.
- Daoud E, et al. Intracardiac echocardiography to guide transseptal left heart catheterization for radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 1999;10:358.
- Verma A, et al. Pulmonary vein antrum isolation: intracardiac echocardiography-guided technique. J Cardiovasc Electrophysiol. 2004;15:1335.
- Marrouche NF, et al. Phased array intracardiac echocardiography monitoring during pulmonary vein isolation in patients with atrial fibrillation: impact on outcome and complications. Circulation. 2003;107:2710.
- Ferguson JD, et al. Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol. 2009;2:611.
- Cummings JE, et al. Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium. Circulation. 2005;112:459.
- Ren JF, et al. Real-time intracardiac echocardiographic imaging of the posterior left atrial wall contiguous to anterior wall of the esophagus. J Am Coll Cardiol. 2006;48:594.
- Okumura Y, et al. Three-dimensional ultrasound for image-guided mapping and intervention: Methods, Quantitative validation, and clinical feasibility of a novel multimodality image mapping system. Circ Arrhythm Electrophysiol. 2008;1:110.
- Orlov MV, et al. Three-dimensional rotational angiography of the left atrium and esophagus: a virtual computed tomography scan in the electrophysiology lab? Heart Rhythm. 2007;4:37.
- Thiagalingam A, et al. Intraprocedural volume imaging of the left atrium and pulmonary veins with rotational X-ray angiography: implications for catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19:293.
- Orlov MV, et al. How to perform and interpret rotational angiography in the electrophysiology laboratory. Heart Rhythm. 2009;6:1830.
- Li JH, et al. Segmentation and registration of three-dimensional rotational angiogram on live fluoroscopy to guide atrial fibrillation ablation: A new online imaging tool. Heart Rhythm. 2009;6:231.
- Knecht S, et al. Prospective randomized comparison between the conventional electroanatomical system and three-dimensional rotational angiographyduring catheter ablation for atrial fibrillation. Heart Rhythm. 2010 in press.
Source: PubMed