title: Effect of catheter tip-tissue surface contact on three-dimensional left atrial and pulmonary vein geometries: potential anatomic distortion of 3D ultrasound, fast anatomical mapping, and merged 3D CT-derived images.
abstract: Anatomic Distortion of 3D Mapping.
  
  
  BACKGROUND
  Although catheter tip-tissue contact is known as a reliable basis for mapping and ablation of atrial fibrillation (AF), the effects of different mapping methods on 3-dimensional (3D) map configuration remain unknown.
  
  
  RESULTS
  Twenty AF patients underwent Carto-based 3D ultrasound (US) evaluation. Left atrium (LA)/pulmonary vein (PV) geometry was constructed with the 3D US system. The resulting geometry was compared to geometries created with a fast electroanatomical mapping (FAM) algorithm and 3D US merged with computed tomography (merged 3D US-CT). The 3D US-derived LA volumes were smaller than the FAM- and merged 3D US-CT-derived volumes (75 ± 21 cm(3) vs 120 ± 20 cm(3) and 125 ± 25 cm(3) , P < 0.0001 for both). Differences in anatomic PV orifice fiducials between 3D US- and FAM- and merged 3D US-CT-derived geometries were 6.0 (interquartile range 0-9.3) mm and 4.1 (0-7.0) mm, respectively. Extensive encircling PV isolation guided by 3D US images with real-time 2D intracardiac echocardiography-based visualization of catheter tip-tissue contact generated ablation point (n = 983) drop-out at 1.9 ± 3.8 mm beyond the surface of the 3D US-derived LA/PV geometry. However, these same points were located 1.5 ± 5.4 and 0.4 ± 4.1 mm below the FAM- and merged 3D US-CT-derived surfaces.
  
  
  CONCLUSIONS
  Different mapping methods yield different 3D geometries. When AF ablation is guided by 3D US-derived images, ablation points fall beyond the 3D US surface but below the FAM- or merged 3D US-CT-derived surface. Our data reveal anatomic distortion of 3D images, providing important information for improving the safety and efficacy of 3D mapping-guided AF ablation. (J Cardiovasc Electrophysiol, Vol. 24, pp. 259-266, March 2013).
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. yasuwo128@yahoo.co.jp
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Okumura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kofune
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Sonoda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mano
authors.forename: Kimie
authors.initials: K
authors.lastname: Ohkubo
authors.forename: Toshiko
authors.initials: T
authors.lastname: Nakai
authors.forename: Naoko
authors.initials: N
authors.lastname: Sasaki
authors.forename: Rikitake
authors.initials: R
authors.lastname: Kogawa
authors.forename: Ayako
authors.initials: A
authors.lastname: Maruyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D016009:Chi-Square Distribution; D019560:Echocardiography, Three-Dimensional; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011857:Radiographic Image Interpretation, Computer-Assisted; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome