Combined cardiac and respiratory motion compensation for atrial fibrillation ablation procedures.

Catheter ablation of atrial fibrillation has become an accepted treatment option if a patient no longer responds to or tolerates drug therapy. A main goal is the electrical isolation of the pulmonary veins attached to the left atrium. Catheter ablation may be performed under fluoroscopic image guidance. Due to the rather low soft-tissue contrast of X-ray imaging, the heart is not visible in these images. To overcome this problem, overlay images from pre-operative 3-D volumetric data can be used to add anatomical detail. Unfortunately, this overlay is compromised by respiratory and cardiac motion. In the past, two methods have been proposed to perform motion compensation. The first approach involves tracking of a circumferential mapping catheter placed at an ostium of a pulmonary vein. The second method relies on a motion estimate obtained by localizing an electrode of the coronary sinus (CS) catheter. We propose a new motion compensation scheme which combines these two methods. The effectiveness of the proposed method is verified using 19 real clinical data sets. The motion in the fluoroscopic images was estimated with an overall average error of 0.55 mm by tracking the circumferential mapping catheter. By applying an algorithm involving both the CS catheter and the circumferential mapping catheter, we were able to detect motion of the mapping catheter from one pulmonary vein to another with a false positive rate of 5.8 %.