title: Validation of three-dimensional cardiac image integration: use of integrated CT image into electroanatomic mapping system to perform catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Accurate visualization of the complex left atrial (LA) anatomy and the location of an ablation catheter within the chamber is important in the success and safety of ablation for atrial fibrillation (AF). We describe the integration of CT into an electroanatomic mapping (EAM) system and its validation in patients undergoing catheter ablation for AF.
  
  
  RESULTS
  Thirty patients (59.2 +/- 8 years, 25 M) with paroxysmal (12) and persistent (18) AF underwent ablation using CT image integration into an electroanatomic mapping system. CT registration using the pulmonary veins as markers (landmark) was achieved with an error of 6.4 +/- 2.8 mm with repeat registration required in two patients. Registration of the CT by best fit to a electroanatomic geometry (surface) was achieved with an error of 2.3 +/- 0.4 mm. There was no significant difference in the regional LA registration error at superior (1.7 +/- 0.7 mm), inferior (2.2 +/- 1.4 mm), septal (1.7 +/- 0.8 mm), and lateral (1.7 +/- 0.7 mm, P = 0.13) sites. Cardiac rhythm at the time of CT did not have a significant effect on total or regional surface registration accuracy (mean total 2.5 +/- 0.3 in AF patients vs 2.3 +/- 0.5 in SR patients, P = 0.22). The integrated CT was used to guide the encirclement of the pulmonary veins (PV) in pairs with electrical isolation achieved by maintaining ablation along the ablation line in 58 of 60 PV pairs. Postprocedural PV angiography did not demonstrate significant stenosis.
  
  
  CONCLUSIONS
  CT image integration into an EAM system was successfully performed in patients undergoing catheter ablation for AF. With a greater appreciation of the complex and variable nature of the PV and LA anatomy this new technology may improve the efficacy and safety of the procedure.
authors.affiliation: Department of Cardiology, St. Bartholomew's Hospital and Queen Mary University, London EC1A 7BE, United Kingdom.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.forename: Stuart
authors.initials: S
authors.lastname: Harris
authors.forename: Dominic
authors.initials: D
authors.lastname: Abrams
authors.forename: Stephen
authors.initials: S
authors.lastname: Ellis
authors.forename: Simon C
authors.initials: SC
authors.lastname: Sporton
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome