Address for reprints: Claudio Pratola, M.D., Chair of Cardiology, S. Anna University Hospital, Corso Giovecca 203, 44100 Ferrara, Italy. Fax: 39 0532 236593; e-mail: [email protected]

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Abstract

Background: Different image integration modalities are available for atrial fibrillation (AF) ablation, but their impact on procedural and fluoroscopy times has not been evaluated yet.

Methods: Sixty patients (mean age 52.2 ± 12.0 years, 48.3% men, 75% paroxysmal AF) undergoing pulmonary vein (PV) encircling with PV disconnection for symptomatic drug-refractory AF were randomized to ablation with CARTO electroanatomical mapping (Biosense Webster, Diamond Bar, CA, USA) integrated with: (1) preprocedural magnetic resonance imaging (MRI; Group 1); (2) intracardiac echocardiography (ICE; Group 2); (3) preprocedural MRI and ICE (Group 3).

Results: PV disconnection was achieved in all patients. Total procedural time (Group 1: 124.7 ± 47.0; Group 2: 112.5 ± 30.4; Group 3: 108.6 ± 34.7 minutes) and total ablation time were similar between groups (P = ns). MRI integration alone required a higher fluoroscopy time (23.8 ± 6.9 in Group 1 vs 11.0 ± 2.3 and 13.9 ± 4.2 minutes in Groups 2 and 3, respectively; P < 0.005) and a longer time spent in the left atrium (109.0 ± 43.5 in Group 1 vs 78.2 ± 29.7 and 74.8 ± 34.3 minutes in Groups 2 and 3, respectively; P = 0.03) in comparison to ICE integration. Addition of MRI to ICE integration showed a tendency for a higher fluoroscopy time in comparison to ICE integration alone (P = 0.06). At a mean follow-up of 9.1 ± 2.2 months, there were no significant differences in AF recurrences among the groups (P = ns).

Conclusion: ICE image integration significantly reduces the fluoroscopy time and the time spent in the left atrium in comparison to MRI integration alone. Addition of MRI to ICE integration does not reduce total procedural time and seems to lead to higher fluoroscopy time in comparison to ICE integration alone. (PACE 2011; 34:422–430)

References

1 Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, Damiano RJ Jr, et al.; Heart Rhythm Society; European Heart Rhythm Association; European Cardiac Arrhythmia Society; American College of Cardiology; American Heart Association; Society of Thoracic Surgeons. HRS/EHRA/ECAS Expert Consensus Statement on Catheter Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures, Follow-Up. A Report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in Partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in Collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the Governing Bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace 2007; 9: 335–379.
PubMed Google Scholar
2 Tops LF, Schalij MJ, den Uijl WD, Abraham TP, Calkins H, Bax JJ. Image integration in catheter ablation of atrial fibrillation. Europace 2008; 10: iii48– iii56.
10.1093/europace/eun235
PubMed Web of Science® Google Scholar
3 Malchano ZJ, Neuzil P, Cury RC, Holmvang G, Weichet J, Schmidt EJ, Ruskin JN, et al. Integration of cardiac CT/MR imaging with three dimensional electroanatomic mapping to guide catheter manipulation in the left atrium: Implications for catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2006; 17: 1221–1229.
10.1111/j.1540-8167.2006.00616.x
Google Scholar
4 Dong J, Dickfeld T, Dalal D, Cheema A, Vasamreddy CR, Henrikson CA, Marine JE, et al. 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 2006; 17: 459–466.
10.1111/j.1540-8167.2006.00425.x
CAS PubMed Web of Science® Google Scholar
5 Kistler PM, Earley MJ, Harris S, Abrams D, Ellis S, Sporton SC, Schilling RJ. Validation of three-dimensional cardiac image integration: Use of integrated CT image into electroanatomic mapping system to perform ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2006; 17: 341–348.
10.1111/j.1540-8167.2006.00371.x
Google Scholar
6 Tops LF, Bax JJ, Zeppenfeld K, Jongbloed MR, Lamb HJ, Van Der Wall EE, Schalij MJ. Fusion of multislice computed tomography imaging with three-dimensional electroanatomic mapping to guide radiofrequency catheter ablation procedures. Heart Rhythm 2005; 2: 1076–1081.
10.1111/j.1540-8167.2006.00371.x
PubMed Web of Science® Google Scholar
7 Martinek M, Nesser HJ, Aichinger J, Boehm G, Purerfellner H. 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 2007; 30: 1215–1223.
10.1111/j.1540-8159.2007.00843.x
CAS Google Scholar
8 Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G, Angkeow P, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation. Lessons learned by use of magnetic resonance imaging. Circulation 2003; 107: 2004–2010.
10.1161/01.CIR.0000061951.81767.4E
PubMed Web of Science® Google Scholar
9 Packer DL, Johnson SB, Kolasa MW, Bunch TJ, Henz BD, Okumura Y. New generation of electro-anatomic mapping: Full intracardiac ultrasound image integration. Europace 2008; 10: iii35–iii41.
10.1093/europace/eun231
PubMed Web of Science® Google Scholar
10 Khaykin Y, Klemm O, Verma A. First human experience with real-time integration of intracardiac echocardiography and 3D electroanatomical imaging to guide right free wall accessory pathway ablation. Europace 2008; 10: 116–117.
10.1093/europace/eum243
PubMed Web of Science® Google Scholar
11 Singh SM, Heist EK, Donaldson DM, Collins RM, Chevalier J, Mela T, Ruskin JN, et al. Image integration using intracardiac ultrasound to guide catheter ablation of atrial fibrillation. Heart Rhythm 2008; 6: 1548–1555.
10.1016/j.hrthm.2008.08.027
Web of Science® Google Scholar
12 Ren JF, Marchlinski FE. Utility of intracardiac echocardiography in left heart ablation for tachyarrhythmias. Echocardiography 2007; 24: 533–540.
10.1111/j.1540-8175.2007.00426.x
CAS PubMed Web of Science® Google Scholar
13 den Uijl WD, Tops LF, Tolosana JM, Schuijf JD, Trines S, Zeppenfeld K, Bax JJ, et al. Real-time integration of intracardiac echocardiography and multislice computed tomography to guide radiofrequency catheter ablation for atrial fibrillation. Heart Rhythm 2008; 5: 1403–1410.
10.1016/j.hrthm.2008.07.020
PubMed Web of Science® Google Scholar
14 Mantovan R, Verlato R, Calzolari VC, Baccillieri S, De Leo A, Turrini P, Pastore G, et al. Comparison between anatomical and integrated approaches to atrial fibrillation ablation: Adjunctive role of electrical pulmonary vein disconnection. J Cardiovasc Electrophysiol 2005; 16: 1293–1297.
10.1111/j.1540-8167.2005.00217.x
CAS Google Scholar
15 Pratola C, Baldo E, Notarstefano P, Toselli T, Ferrari R. Radiofrequency ablation of atrial fibrillation: Is the persistence of all intraprocedural targets necessary for long-term maintenance of sinus rhythm? Circulation 2008; 117: 136–143.
10.1161/CIRCULATIONAHA.106.678789
PubMed Web of Science® Google Scholar
16 Bertaglia E, Brandolino G, Zoppo F, Zerbo F, Pascotto P. 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: 273–282.
10.1111/j.1540-8159.2008.00986.x
CAS PubMed Web of Science® Google Scholar
17 Khaykin Y, Skanes A, Wulffhart ZA, Gula L, Whaley B, Oosthuizen R, Seabrook C, et al. Intracardiac ECHO integration with three dimensional mapping: Role in AF ablation. Journal of Atrial Fibrillation 2008; 1: 74–82.
10.4022/jafib.v1i1.402
Google Scholar
18 Nickoloff EL, Anderson PO. Radiation exposures to patients from CT: Reality, public perception, and policy. Am J Roentgenol 2001; 177: 285–287.
10.2214/ajr.177.2.1770285
CAS PubMed Web of Science® Google Scholar
19 Hunold P, Vogt FM, Schmermund A, Debatin JF, Kerkhoff G, Budde T, Erbel R, et al. Radiation exposure during cardiac CT: Effective doses at multi-detector row T and electron-beam CT. Radiology 2003; 226: 145–152.
10.1148/radiol.2261011365
PubMed Web of Science® Google Scholar
20 Zhong H, Lacomis J, Schwartzman D. On the accuracy of CartoMerge for guiding posterior left atrial ablation in man. Heart Rhythm 2007; 4: 595–602.
10.1016/j.hrthm.2007.01.033
PubMed Web of Science® Google Scholar
21 Okumura Y, Henz B, Johnson S, Bunch TJ, O’Brien CJ, Hodge DO, Altman A, et al. Three-dimensional ultrasound for image-guided mapping and intervention: Methods, quantitative validation, and clinical feasibility of a novel multimodality image mapping system. Circulation Arrhythmia 2008; 1: 110–119.
10.1161/CIRCEP.108.769935
PubMed Web of Science® Google Scholar
22 Sra J. Registration of three dimensional left atrial images with interventional systems. Heart 2005; 91: 1098–1104.
10.1136/hrt.2004.045039
PubMed Web of Science® Google Scholar
23 Rubenstein J, Kadish A. Three-dimensional image integration: A first experience with guidance of atrial fibrillation ablations. J Cardiovasc Electrophysiol 2006; 17: 467–468.
10.1111/j.1540-8167.2006.00449.x
CAS PubMed Web of Science® Google Scholar
24 Daccarett M, Sergersin NM, Günter J, Nölker G, Gutleben K, Brachmann J, Marrouche NF. Blinded correlation study of three-dimensional electro-anatomical image integration and phased array intra-cardiac echocardiography for left atrial mapping. Europace 2007; 9: 923–926.
10.1093/europace/eum192
PubMed Web of Science® Google Scholar
25 Fahmy TS, Milcochova H, Wazni OM, Patel D, Cihak R, Kanj M, Beheiry S, et al. Intracardiac echo-guided image integration: Optimizing strategies for registration. J Cardiovasc Electrophysiol 2007; 18: 276–282.
10.1111/j.1540-8167.2007.00727.x
PubMed Web of Science® Google Scholar

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Volume34, Issue4

April 2011

Pages 422-430

Different Image Integration Modalities to Guide AF Ablation: Impact on Procedural and Fluoroscopy Times

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Different Image Integration Modalities to Guide AF Ablation: Impact on Procedural and Fluoroscopy Times

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