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Left atrial model reconstruction in atrial fibrillation ablation: reliability of new mapping and complex impedance systems.
- Source :
-
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2017 Nov 01; Vol. 19 (11), pp. 1804-1809. - Publication Year :
- 2017
-
Abstract
- Aims: The effectiveness of atrial fibrillation (AF) ablation relies on detailed knowledge of the anatomy of the left atrium (LA) and pulmonary veins (PVs). It is common to combine computed tomography/magnetic resonance (CT/MR) with imaging by electroanatomical (EA) mapping systems. The aim of this study was to evaluate the accuracy of LA anatomical reconstruction by 'One Model' and 'VeriSense' tools (Ensite Velocity 3.0, St Jude Medical), compared with CT/MR imaging.<br />Methods and Results: Seventy-two patients with AF underwent pre-procedural imaging (97% CT-scan, 3% MR imaging) and transcatheter ablation of PVs. Operators were blinded to CT/MR imaging. Electrical Coupling Index (ECI) was used to recognize venous structures when the circular catheter could not. The LA 'One Model' map was obtained without complications; all 124 main left PVs and 144 main right PVs were detected. Nine of 9 intermediate right PVs and 30 of 30 early branches were detected, whereas 1 of the 27 early branches on the right inferior PVs was missed. Comparison between LA intervein distances measured on the roof (RO) and the posterior wall (PW) showed a high correspondence between the EA model and CT/MR imaging (RO CT/MR imaging vs. EA: 32 ± 7 vs. 32 ± 7 mm; PW CT/MR imaging vs. EA: 36 ± 6 vs. 36 ± 7 mm). The EA model yielded slightly larger PV ostia diameters, owing to the distortion caused by catheter pressure.<br />Conclusions: Recent 3D mapping tools allow outstanding anatomical rendering and are key in complex ablation procedure set-up. This study shows that 3D anatomical reconstruction of LA, PVs, and their variable branches is not only safe and fast but also accurate and reliable.<br /> (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions, please email: journals.permissions@oup.com.)
- Subjects :
- Action Potentials
Aged
Atrial Fibrillation physiopathology
Atrial Fibrillation surgery
Catheter Ablation
Clinical Decision-Making
Female
Heart Atria physiopathology
Heart Atria surgery
Heart Rate
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Predictive Value of Tests
Pulmonary Veins physiopathology
Pulmonary Veins surgery
Radiographic Image Interpretation, Computer-Assisted
Reproducibility of Results
Signal Processing, Computer-Assisted
Atrial Fibrillation diagnostic imaging
Electrophysiologic Techniques, Cardiac
Heart Atria diagnostic imaging
Magnetic Resonance Imaging
Models, Cardiovascular
Multimodal Imaging methods
Patient-Specific Modeling
Pulmonary Veins diagnostic imaging
Tomography, X-Ray Computed
Subjects
Details
- Language :
- English
- ISSN :
- 1532-2092
- Volume :
- 19
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 27702853
- Full Text :
- https://doi.org/10.1093/europace/euw250