Computed tomography model-based treatment of atrial fibrillation and atrial macro-re-entrant tachycardia.
OBJECTIVE
Accurate orientation within true three-dimensional (3D) anatomies is essential for the successful radiofrequency (RF) catheter ablation of atrial fibrillation (AF) and atrial macro-re-entrant tachycardia (MRT). In this prospective study, ablation of AF and MRT was performed exclusively using a pre-acquired and integrated computed tomography (CT) image for anatomical 3D orientation without electro-anatomic reconstruction of the left atrium (LA).


RESULTS
Fifty-four consecutive patients suffering from AF (n = 36) and/or MRT (n = 18) underwent RF catheter ablation. A 3D CT image was registered into the NavX-Ensite system without reconstruction of the atrial chamber anatomy. The quality of CT alignment was assessed and validated according to fluoroscopy information, electrogram characteristics, and tactile feedback at 31 pre-defined LA control points. The ablation of AF as well as mapping and ablation of MRT was performed within the 3D CT anatomy. In all patients, mapping and ablation could be performed without the reconstruction of the respective atrial chamber anatomy. The overall CT alignment was highly accurate with true surface contact in 90% (84%; 100%) of the control points. Complete isolation of all pulmonary vein (PV) funnels was achieved in 35 of 36 patients (97%) with AF. In patients with persistent AF (n = 11), additional isolation of the posterior LA (box lesion) and the placement of a mitral isthmus line were performed. The MRT mechanisms were as follows: around a PV ostium (n = 6), perimitral (n = 4), through LA roof (n = 5), septal (n = 2), and around left atrial appendage (n = 1). After a follow-up of 122 +/- 33 days, 22/25 (88%) patients with paroxysmal AF, 8/11 (73%) with persistent AF, and 16/18 (89%) with MRT remained free from arrhythmia recurrences.


CONCLUSIONS
For patients with AF and MRT, our study shows the feasibility of successful placement of complex linear ablation line concepts guided by an integrated 3D image anatomy alone rather than catheter-based virtual chamber surface reconstructions.
Piorkowski
Christopher
C
Department of Electrophysiology, University of Leipzig, Heart Center, Strümpellstrasse 39, 04289 Leipzig, Germany. cp7026@yahoo.de
Kircher
Simon
S
Arya
Arash
A
Gaspar
Thomas
T
Esato
Masahiro
M
Riahi
Sam
S
Bollmann
Andreas
A
Husser
Daniela
D
Staab
Charlotte
C
Sommer
Philipp
P
Hindricks
Gerhard
G
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003198:Computer Simulation; D019544:Equipment Failure Analysis; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome