Image integration of three-dimensional cone-beam computed tomography angiogram into electroanatomical mapping system to guide catheter ablation of atrial fibrillation.
OBJECTIVE
To evaluate the feasibility of integrating three-dimensional images created by intra-procedural cone-beam computed tomography (CBCT) into three-dimensional electroanatomical maps (EAM) and compare its accuracy with that of pre-procedural multi-slice CT (MSCT).


RESULTS
In 24 patients with drug-refractory atrial fibrillation (AF), atriography using CBCT with pulmonary arterial contrast injection was performed at the beginning of the AF ablation procedure. Intra-procedural CBCT images and pre-procedural MSCT images were individually imported into the EAM system and compared their integration accuracy (point-to-surface distance) of each image and EAM just before ablation. The CBCT images were assessed qualitatively and quantitatively in comparison with MSCT images. All CBCT images were graded as optimal or useful in delineating the left atrium-pulmonary vein anatomy and were successfully integrated with the EAM. Overall, integration accuracy was similar for CBCT and MSCT. However, in 11 patients, the MSCT was performed 5 or more days prior to EAM, resulting in significantly shorter surface-to-point distance in CBCT than that in MSCT (P = 0.047). Radiation exposure with CBCT was significantly reduced compared with MSCT (P < 0.001).


CONCLUSIONS
It is feasible to integrate CBCT image into EAM, and the integration is relatively accurate. Intra-procedural atriography by CBCT may replace pre-procedural MSCT as the imaging source for image integration.
Ejima
Koichiro
K
Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. koichiro@qf6.so-net.ne.jp
Shoda
Morio
M
Yagishita
Daigo
D
Futagawa
Keisuke
K
Yashiro
Bun
B
Sato
Takahiro
T
Manaka
Tetsuyuki
T
Nakajima
Takatomo
T
Ohmori
Hisako
H
Hagiwara
Nobuhisa
N
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D013382:Subtraction Technique; D025321:Surgery, Computer-Assisted / Q000379:methods*; D018511:Systems Integration; D016896:Treatment Outcome