title: First report of image integration of cine-angiography with 3D electro-anatomical mapping of the right ventricle in postoperative tetralogy of Fallot.
abstract: Ventricular tachycardia and, more rarely, sudden cardiac death are potential complications affecting the long-term outcome after Tetralogy of Fallot (ToF) repair. Intraventricular septal scar, fibro-fatty substitution around infundibular resection and patchy myocardial fibrosis may provide anatomical substrates of abnormal depolarization and repolarization causing reentrant ventricular arrhythmias. Recently, three-dimensional electro-anatomical mapping (3D EAM) has allowed to investigate the electro-anatomical status of the right ventricle. Radiation exposure during cardiac electrophysiological procedures is still a major concern. We report the first case of 3D mapping of the right ventricle in a postoperative ToF patient performed with a new module of the CARTO® 3 System-the CARTOUnivu™ Module-that combines, simultaneously, fluoroscopic images or cine-angiographic sequences with 3D cardiac mapping to allow real-time visualization of the electrocatheter during the 3D EAM reconstruction. The same volume, previously evaluated with cardiac MRI, was mapped. A perfect match of the diastolic edges of the RV obtained either by cine-loop acquisition during contrast fluoroscopy and by the 3D EAM, was observed. The fluoroscopy time for 3D EAM was 10 s. In conclusion, CARTOUnivu™ Module can integrate, in real time, fluoroscopic images/cine-angiography in virtual biplane view and the 3D EAM allowing a contextual visualization of position and movement of all electrocatheters. This can further increase the accuracy of the 3D EAM in very complex-operated congenital heart diseases, even decreasing radiation exposure.
authors.affiliation: Pediatric Arrhythmia Unit and Syncope Unit, Bambino Gesù Pediatric Hospital, IRCCS, Via Torre di Palidoro snc, 00050, Palidoro, Fiumicino, RM, Italy, mario.russo@opbg.net.
authors.forename: Mario Salvatore
authors.initials: MS
authors.lastname: Russo
authors.forename: Daniela
authors.initials: D
authors.lastname: Righi
authors.forename: Corrado
authors.initials: C
authors.lastname: Di Mambro
authors.forename: Valentina
authors.initials: V
authors.lastname: Ruoppolo
authors.forename: Massimo Stefano
authors.initials: MS
authors.lastname: Silvetti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
mesh_terms: D000200:Action Potentials; D006328:Cardiac Catheterization / Q000295:instrumentation; D062906:Cardiac Catheters; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002932:Cineangiography; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation; D004867:Equipment Design; D005471:Fluoroscopy; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome