The Role of Angle in the Evaluation of Ablation Accuracy in Pulmonary Vein Isolation Navigated by Image Integration

Authors

  • Song-Wen Chen Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Li-Dong Cai Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Tetsuya Asakawa Department of Neurosurgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu-city, Shizuoka, Japan
  • Gen-Qing Zhou Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Yong Wei Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Bao-Zhen Qi Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Zhi-Yu Ling Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Hai-Qing Wu Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Juan Xu Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Shao-Wen Liu Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

DOI:

https://doi.org/10.1532/hsf.2231

Abstract

Background: The conventional index for ablation accuracy is to compare the distance between mapping points with and without treatment by using image integration. We attempted to quantitatively evaluate the role of angle as an index in the ablation accuracy in patients with atrial fibrillation (AF).

Methods: A total of 48 patients with AF were included in the present study. Virtual fluoroscopy planes were predicted by pulmonary vein (PV) angiography, and the standard image planes were defined on the basis of the computed tomography images. Ablations were performed, guided by image integration; and the ablation planes were defined by the actual ablation rings. The predicted angle (distance) was defined as the angle (distance) between the fluoroscopy (predicted) plane and image (standard) plane, whereas the actual angle (distance) was defined as the angle (distance) between the ablation (actual) planes and the image (standard) planes.

Results: We found that all actual angles were significantly smaller than the predicted angles (P <.05), but only the actual distances in the left PV, right inferior PV, right superior PV, and right PV were significantly smaller; the distances in the left inferior PV and left superior PV were not significantly different (P >.05).

Conclusion: Our finding indicates that both the angle and the distance can be significantly reduced by navigation with image integration, but that the angle exhibited better sensitivity than the conventional index of distance. We suggest that the angle should be considered as a new index for ablation accuracy.

References

Bertaglia E, Della Bella P, Tondo C, et al. 2009. Image integration increases efficacy of paroxysmal atrial fibrillation catheter ablation: results from the CartoMerge™ Italian Registry. Europace 11:1004-10.

Calkins H, Kuck KH, Cappato R, et al. 2012. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 33:171-257.

Chen S, Meng W, He DS, et al. 2012. Blocking the pulmonary vein to left atrium conduction in addition to the entrance block enhances clinical efficacy in atrial fibrillation ablation. Pacing Clin Electrophysiol 35:524-31.

Chen S, Lu X, Zhen Y, et al. 2013. Spatial torsion of the ipsilateral superior and inferior pulmonary veins. J Interv Card Electrophysiol 37:35-40.

Desjardins B. 2016. Imaging for cardiac electrophysiology. SA J Radiol 20:a1048.

Dong J, Dickfeld T, Dalal D, et al. 2006. Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17: 459-66.

Kimura M, Sasaki S, Owada S, et al. 2013. Validation of accuracy of three-dimensional left atrial CartoSound™ and CT image integration: influence of respiratory phase and cardiac cycle. J Cardiovasc Electrophysiol 24:1002-7.

Kistler PM, Rajappan K, Jahngir M, et al. 2006. The impact of CT image integration into an electroanatomic mapping system on clinical outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17:1093-101.

Mansour M, Holmvang G, Sosnovik D, et al. 2004. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging. J Cardiovasc Electrophysiol 15: 387-93.

Marai I, Suleiman M, Blich M, Lessick J, Abadi S, Boulos M. 2016. Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation. World J Cardiol 8:317-22.

Martinek M, Nesser HJ, Aichinger J, Boehm G, Purerfellner H. 2007. Impact of integration of multislice computed tomography imaging into three-dimensional electroanatomic mapping on clinical outcomes, safety, and efficacy using radiofrequency ablation for atrial fibrillation. Pacing Clin Electrophysiol 30: 1215-23.

Shigenaga Y, Okajima K, Ikeuchi K, et al. 2016. Usefulness of non–contrast-enhanced MRI with two-dimensional balanced steady-state free precession for the acquisition of the pulmonary venous and left atrial anatomy pre catheter ablation of atrial fibrillation: Comparison with contrast enhanced CT in clinical cases. J Magn Reson Imaging 43:495-503.

Tops LF, Bax JJ, Zeppenfeld K, et al. 2005. Fusion of multislice computed tomography imaging with three-dimensional electroanatomic mapping to guide radiofrequency catheter ablation procedures. Heart Rhythm 2:1076-81.

Published

2018-11-06

How to Cite

Chen, S.-W., Cai, L.-D., Asakawa, T., Zhou, G.-Q., Wei, Y., Qi, B.-Z., Ling, Z.-Y., Wu, H.-Q., Xu, J., & Liu, S.-W. (2018). The Role of Angle in the Evaluation of Ablation Accuracy in Pulmonary Vein Isolation Navigated by Image Integration. The Heart Surgery Forum, 21(6), E438-E442. https://doi.org/10.1532/hsf.2231

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