title: Computed tomography-fluoroscopy image integration-guided catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  This study examines the feasibility of atrial fibrillation (AF) ablation using registered three-dimensional computed tomography (CT) images of the left atrium with fluoroscopy.
  
  
  RESULTS
  A total of 50 consecutive patients with symptomatic AF refractory to medical therapy (32 paroxysmal, 18 persistent, age 55 +/- 10 years) were randomized to undergo a catheter-based AF ablation procedure with or without the CT-fluoroscopy guidance system. All patients underwent preprocedural contrast-enhanced CT imaging and segmentation of the left atrium. For the CT-fluoroscopy group, circumferential lesions encompassing the pulmonary vein (PV) antrum and linear lesions along the roof of the left atrium between the superior PVs and the mitral isthmus were created on the CT image, which was registered with real-time fluoroscopy. The registered images were then used to navigate the ablation catheters to the sites of planned ablation. After the ablation sites were completed, any remaining PV potentials were isolated with electrophysiological guidance. In the control patients, the same technique was performed without using the CT-fluoro guidance system. CT scans were accurately registered to fluoroscopic images with minimal manual correction. Operators could navigate catheters on the registered images to preplanned, extraostial sites for ablation. CT-fluoroscopy guidance decreased procedure duration and fluoro times (P < 0.05). At a mean follow-up of 9 +/- 2 months, 21 patients (84%) in the CT-fluoro guidance group and 16 patients (64%) in the control group have had no recurrence of AF.
  
  
  CONCLUSIONS
  CT-fluoroscopic-guided left atrial ablation is feasible and allows appropriate catheter manipulation in the left atrium.
authors.affiliation: Electrophysiology Laboratories of Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA. bdanek@hrtcare.com
authors.forename: Jasbir
authors.initials: J
authors.lastname: Sra
authors.forename: Girish
authors.initials: G
authors.lastname: Narayan
authors.forename: David
authors.initials: D
authors.lastname: Krum
authors.forename: Angela
authors.initials: A
authors.lastname: Malloy
authors.forename: Ryan
authors.initials: R
authors.lastname: Cooley
authors.forename: Atul
authors.initials: A
authors.lastname: Bhatia
authors.forename: Anwer
authors.initials: A
authors.lastname: Dhala
authors.forename: Zalmen
authors.initials: Z
authors.lastname: Blanck
authors.forename: Vikram
authors.initials: V
authors.lastname: Nangia
authors.forename: Masood
authors.initials: M
authors.lastname: Akhtar
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome