BACKGROUND: Anatomical guided atrial fibrillation (AF) catheter ablation relies on the assumption that the left atrium reconstruction anatomy (LARA) using a 3D mapping system precisely matches the patient's CT scan anatomy (real anatomy). This study investigates whether this postulation is accurate using CT scan image integration. PATIENTS AND METHODS: Thirty consecutive patients (23 men, mean age = 51.9 +/- 9.9 years) with symptomatic drug-refractory paroxysmal (n = 21) or persistent (n = 9) AF underwent a circumferential, 2 x 2, pulmonary vein (PV) radiofrequency (RF) ablation using the CARTOMERGE system. Left atrium (LA) anatomy was first reconstructed and RF design lines drawn on this LARA. After a CT-scan image of the LA was integrated into the 3D system, RF lesions were deployed 10 +/- 5 mm outside the PV ostia (PVO) onto the CT-scan LA surface. The match between the actual RF lines and the RF design lines was analyzed off-line after catheter withdrawal. RESULTS: Circumferential RF design lines were divided into four segments encircling both the right and left PVs. Design segments matched the actual RF segments in a proportion varying from 23% up to 83%. A mean of 2.8 +/- 1.6 segments per patient were inaccurately designed that extended a mean of 3.8 +/- 2.3mm inside the adjacent PV or 6.7 +/- 1.8mm inside the left atrial appendage (LAA). Seven patients (23%) had four or more segments incorrectly designed. CONCLUSIONS: Our study reveals the inaccuracy of 3D anatomic guided RF ablation with respect to the LA anatomical structures that could be possibly improved when combined with CT-scan image integration.
BACKGROUND: Anatomical guided atrial fibrillation (AF) catheter ablation relies on the assumption that the left atrium reconstruction anatomy (LARA) using a 3D mapping system precisely matches the patient's CT scan anatomy (real anatomy). This study investigates whether this postulation is accurate using CT scan image integration. PATIENTS AND METHODS: Thirty consecutive patients (23 men, mean age = 51.9 +/- 9.9 years) with symptomatic drug-refractory paroxysmal (n = 21) or persistent (n = 9) AF underwent a circumferential, 2 x 2, pulmonary vein (PV) radiofrequency (RF) ablation using the CARTOMERGE system. Left atrium (LA) anatomy was first reconstructed and RF design lines drawn on this LARA. After a CT-scan image of the LA was integrated into the 3D system, RF lesions were deployed 10 +/- 5 mm outside the PV ostia (PVO) onto the CT-scan LA surface. The match between the actual RF lines and the RF design lines was analyzed off-line after catheter withdrawal. RESULTS: Circumferential RF design lines were divided into four segments encircling both the right and left PVs. Design segments matched the actual RF segments in a proportion varying from 23% up to 83%. A mean of 2.8 +/- 1.6 segments per patient were inaccurately designed that extended a mean of 3.8 +/- 2.3mm inside the adjacent PV or 6.7 +/- 1.8mm inside the left atrial appendage (LAA). Seven patients (23%) had four or more segments incorrectly designed. CONCLUSIONS: Our study reveals the inaccuracy of 3D anatomic guided RF ablation with respect to the LA anatomical structures that could be possibly improved when combined with CT-scan image integration.
Authors: Jun Dong; Hugh Calkins; Stephen B Solomon; Shenghan Lai; Darshan Dalal; Albert C Lardo; Al Lardo; Erez Brem; Assaf Preiss; Ronald D Berger; Henry Halperin; Timm Dickfeld Journal: Circulation Date: 2006-01-09 Impact factor: 29.690
Authors: Ritsushi Kato; Lars Lickfett; Glenn Meininger; Timm Dickfeld; Richard Wu; George Juang; Piamsook Angkeow; Jennifer LaCorte; David Bluemke; Ronald Berger; Henry R Halperin; Hugh Calkins Journal: Circulation Date: 2003-04-07 Impact factor: 29.690
Authors: Laurens F Tops; Jeroen J Bax; Katja Zeppenfeld; Monique R M Jongbloed; Hildo J Lamb; Ernst E van der Wall; Martin J Schalij Journal: Heart Rhythm Date: 2005-10 Impact factor: 6.343
Authors: Peter A Noseworthy; Zachary J Malchano; Jameel Ahmed; Godtfred Holmvang; Jeremy N Ruskin; Vivek Y Reddy Journal: Heart Rhythm Date: 2005-11 Impact factor: 6.343
Authors: M Haïssaguerre; D C Shah; P Jaïs; M Hocini; T Yamane; I Deisenhofer; M Chauvin; S Garrigue; J Clémenty Journal: Circulation Date: 2000-11-14 Impact factor: 29.690
Authors: C Pappone; S Rosanio; G Oreto; M Tocchi; F Gugliotta; G Vicedomini; A Salvati; C Dicandia; P Mazzone; V Santinelli; S Gulletta; S Chierchia Journal: Circulation Date: 2000-11-21 Impact factor: 29.690
Authors: M Haïssaguerre; P Jaïs; D C Shah; A Takahashi; M Hocini; G Quiniou; S Garrigue; A Le Mouroux; P Le Métayer; J Clémenty Journal: N Engl J Med Date: 1998-09-03 Impact factor: 91.245