title: Blinded correlation study of three-dimensional electro-anatomical image integration and phased array intra-cardiac echocardiography for left atrial mapping.
abstract: OBJECTIVE
  The purpose of this study was to compare, in a prospective and operator-blinded fashion, the mapping accuracy of the three-dimensional (3D) electro-anatomical image integration and phased array intracardiac echocardiography (ICE) as a real-time imaging modality.
  
  
  RESULTS
  Prospectively, 18 patients undergoing pulmonary vein antrum isolation (PVAI) were included. Patients underwent a cardiac computerized tomography scan to define PV and left atrial (LA) anatomy. Image segmentation and integration was performed by CARTOMERGE, followed by 3D volume rendering and image integration. Error profiles between ICE-guided to CARTO and CARTO-guided to ICE were performed in an operator-blinded fashion over PV predetermined points. All patients underwent successful PVAI. The mean age was 55 +/- 10 years, with a mean LA size of 4.5 +/- 0.3 cm. CARTOMERGE-guided catheter positioning was subject to spatial errors on the order of 0.5-1.0 cm relative to ICE imaging, with greatest magnitude near the LA appendage (LAA) and least near the RIPV. The magnitude of spatial error between these two methods is demonstrable regardless of the choice of reference.
  
  
  CONCLUSIONS
  During electro-anatomical mapping of the LA, CARTO-guided navigation is associated with considerable spatial error relative to anatomic features as identified by ICE. Adjunctive real-time imaging is needed to ensure accurate delivery of radiofrequency lesions.
authors.affiliation: Division of Cardiac Electrophysiology, University of Utah Health Science Center, 4A100, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Marcos
authors.initials: M
authors.lastname: Daccarett
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Segerson
authors.forename: Jens
authors.initials: J
authors.lastname: Günther
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
authors.forename: Klaus
authors.initials: K
authors.lastname: Gutleben
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis; D002309:Cardiology / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results