title: Ablation of atrial fibrillation using novel 4-dimensional catheter tracking within autoregistered left atrial angiograms.
abstract: BACKGROUND
  We describe a novel fluoroscopy coregistered, 4-dimensional catheter tracking technology (MediGuide Technology [MGT]) used for treatment of patients with atrial fibrillation. The aim of the study was to investigate (1) the feasibility of nonfluoroscopic catheter manipulation within dynamic left atrial chamber models; (2) the integration of the technology into an established electroanatomical mapping system; and (3) potential clinical impact.
  
  
  RESULTS
  Forty-nine patients received atrial fibrillation ablation using MGT-enabled NavX-EnSite. Matched patients ablated with a conventional NavX-EnSite system served as a control group. MGT was used for the deployment of diagnostic catheters within preacquired cine loops, for nonfluoroscopic chamber mapping within dynamic angiograms, and for 4-dimensional tagging of anatomical landmarks. Integration with the electroanatomical mapping system allowed correction of field distortions and a reference tool to detect and correct map shifts. Catheter ablation was done without MGT because the ablation catheter was not MGT enabled. MGT worked safely and stably in all 49 patients. Catheter deployment within the preacquired cine loops was successfully performed in 45 of 49 (92%) patients. Catheter tracking within dynamic left atrial angiograms allowed nearly nonfluoroscopic creation of NavX-EnSite geometries with subsequent computed tomography model registration in all 49 patients. Overall, MGT significantly reduced total procedural fluoroscopy time (median [quartiles]) from 31 minutes (25, 43 minutes) to 16 minutes (10, 23 minutes) and irradiation dose from 14 453±7403 to 7363±5827 cGy*cm(2) (mean±SD), respectively (P<0.001).
  
  
  CONCLUSIONS
  MGT is a tracking technology that allows 4-dimensional visualization of dedicated catheters within moving chamber models. Integration of the MGT with an established electroanatomical mapping system provided algorithms to facilitate mapping in the electroanatomical mapping system environment. As a first measurable clinical impact, MGT was able to reduce fluoroscopy exposure by nearly 50%.
authors: Department of Electrophysiology, University of Leipzig--Heart Center, Leipzig, Germany. sascha.rolf@web.de
authors: Sascha
authors: S
authors: Rolf
authors: Philipp
authors: P
authors: Sommer
authors: Thomas
authors: T
authors: Gaspar
authors: Silke
authors: S
authors: John
authors: Arash
authors: A
authors: Arya
authors: Gerhard
authors: G
authors: Hindricks
authors: Christopher
authors: C
authors: Piorkowski
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D016009:Chi-Square Distribution; D002932:Cineangiography; D015716:Electrocardiography, Ambulatory; D004574:Electromagnetic Fields; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D005858:Germany; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome