title: Respiratory gating algorithm helps to reconstruct more accurate electroanatomical maps during atrial fibrillation ablation performed under spontaneous respiration.
abstract: OBJECTIVE
  Electroanatomical mapping is a useful tool during the ablation of atrial fibrillation. Respiratory movement might influence the mapping accuracy and merging. This study aims to investigate the effect of respiratory gating on the accuracy of magnetic-field-based electroanatomical mapping under spontaneous respiration.
  
  
  METHODS
  Fifty-one consecutive patients (35 male, aged 30-78 years) who underwent left atrial radiofrequency catheter ablation due to atrial fibrillation were included. Electroanatomical mapping was performed with CARTO 3 System under conscious sedation. Respiratory gating was achieved with the AccuResp algorithm (Biosense Webster). Average surface match and maximum distance of the pre-acquired and electroanatomical maps, as well as left atrial volume, were recorded with and without respiratory gating after merging.
  
  
  RESULTS
  The average surface match of the electroanatomical map with the left atrial reconstruction was significantly better with respiratory gating than without using the algorithm (3.81 ± 1.09 vs 4.11 ± 1.61 mm, p = 0.0119). It was not dependent of the rhythm during mapping or the image modality used for left atrial reconstruction. The maximal distance between the two maps did not depend on the use of the algorithm (19.81 ± 6.24 mm for gated and 20.87 ± 7.99 mm for non-gated, p = 0.3161). Left atrial volume of the map was significantly lower when using the respiratory compensation module (106.3 ± 31.6 vs 127.0 ± 36.4 ml, p < 0.0001) and showed a significant correlation with the pre-recorded 3D reconstruction volumes (r = 0.66, p < 0.0001).
  
  
  CONCLUSIONS
  The use of the novel respiratory gating algorithm might improve the accuracy of electroanatomical mapping during left atrial ablation under conscious sedation. The possible impact on the effectiveness of the ablation needs to be further evaluated.
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Széplaki
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Gellér
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: Emin Evren
authors.initials: EE
authors.lastname: Özcan
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Tahin
authors.affiliation: Department of Cardiology, Markusovszky Egyetemi Oktatókórház, Szombathely, Hungary.
authors.forename: Orsolya Mária
authors.initials: OM
authors.lastname: Kovács
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: Nóra
authors.initials: N
authors.lastname: Parázs
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: Júlia
authors.initials: J
authors.lastname: Karády
authors.affiliation: MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University Budapest, Budapest, Hungary.
authors.forename: Pál
authors.initials: P
authors.lastname: Maurovich-Horvat
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Szilágyi
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Osztheimer
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Tóth
authors.affiliation: Heart and Vascular Center, Semmelweis University Budapest, 68 Városmajor street, Budapest, 1122, Hungary. merkely.bela@kardio.sote.hu.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
mesh_terms: D000328:Adult; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D021621:Imaging, Three-Dimensional; D008297:Male; D009038:Motion; D015203:Reproducibility of Results; D055425:Respiratory-Gated Imaging Techniques; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Accuracy; Atrial fibrillation; Catheter ablation; Electroanatomical mapping; Respiratory gating; Spontaneous respiration
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