Intraprocedural reconstruction of the left atrium and pulmonary veins as a single navigation tool for ablation of atrial fibrillation: a feasibility, efficacy, and safety study.
BACKGROUND
Pulmonary vein (PV) isolation is a technically challenging intervention. For this reason, integration of three-dimensional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) in order to enhance effectiveness and safety has been widely adopted. A novel imaging approach--intraprocedural rotational angiography and reconstruction of the left atrium and PVs--is feasible and provides high anatomic accuracy.


OBJECTIVE
The purpose of this study was to prove the feasibility, safety, and efficacy of this imaging approach as a single navigation tool for PV isolation.


METHODS
Forty-four patients (25 men and 19 women; age 57 +/- 11 years) with atrial fibrillation (AF) who presented for PV isolation were studied. Rotational angiography during adenosine-induced ventricular asystole was performed under sedation with propofol. The left atrium and PVs were reconstructed by three-dimensional atriography using specialized software (EP navigator prototype, Philips Medical Systems). Three-dimensional atriography was used as a single navigation tool for guiding PV isolation.


RESULTS
Of 176 PVs, 174 (99%) were isolated. Total procedural and fluoroscopy times were 192 +/- 46 minutes and 44 +/- 12 minutes, respectively. During follow-up of 6 +/- 3 months, 31 (70%) patients were free of symptoms and had no evidence of AF without any antiarrhythmic medication. MRI examination of 41 patients at 3-month follow-up excluded PV stenosis. No major complications occurred.


CONCLUSIONS
Three-dimensional atriography is a novel intraprocedural three-dimensional imaging technique that is based on rotational angiography. It can be safely and effectively used as a single navigation tool for performing PV isolation.
Kriatselis
Charalampos
C
Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. kriatselis@dhzb.de
Tang
Min
M
Nedios
Sotirios
S
Roser
Mattias
M
Gerds-Li
Hong
H
Fleck
Eckart
E
D000368:Aged; D000792:Angiography; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome