title: Intra-operative volume imaging of the left atrium and pulmonary veins with rotational X-ray angiography.
abstract: Complex electrophysiology (EP) procedures, such as catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation, require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present a novel application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. We perform two selective contrast-enhanced rotational acquisitions and reconstruct CT-like volumes with 3D filtered back projection. Two volumes depicting the left and right portions of the LAPV are registered and fused. The combined data sets are then visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with pre-acquired CT data and can be of sufficient quality for intra-operative guidance.
authors.affiliation: Philips Research North America, Clinical Sites Research, 345 Scarborough Road, Briarcliff Manor, NY, USA. robert.manzke@philips.com
authors.forename: Robert
authors.initials: R
authors.lastname: Manzke
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
authors.forename: Sandeep
authors.initials: S
authors.lastname: Dalal
authors.forename: Annemarie
authors.initials: A
authors.lastname: Hanekamp
authors.forename: Volker
authors.initials: V
authors.lastname: Rasche
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Chan
mesh_terms: D000465:Algorithms; D000818:Animals; D001185:Artificial Intelligence; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D017023:Coronary Angiography / Q000379:methods*; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000601:surgery*; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine