title: Left atrial model reconstruction in atrial fibrillation ablation: reliability of new mapping and complex impedance systems.
abstract: OBJECTIVE
  The effectiveness of atrial fibrillation (AF) ablation relies on detailed knowledge of the anatomy of the left atrium (LA) and pulmonary veins (PVs). It is common to combine computed tomography/magnetic resonance (CT/MR) with imaging by electroanatomical (EA) mapping systems. The aim of this study was to evaluate the accuracy of LA anatomical reconstruction by 'One Model' and 'VeriSense' tools (Ensite Velocity 3.0, St Jude Medical), compared with CT/MR imaging.
  
  
  RESULTS
  Seventy-two patients with AF underwent pre-procedural imaging (97% CT-scan, 3% MR imaging) and transcatheter ablation of PVs. Operators were blinded to CT/MR imaging. Electrical Coupling Index (ECI) was used to recognize venous structures when the circular catheter could not. The LA 'One Model' map was obtained without complications; all 124 main left PVs and 144 main right PVs were detected. Nine of 9 intermediate right PVs and 30 of 30 early branches were detected, whereas 1 of the 27 early branches on the right inferior PVs was missed. Comparison between LA intervein distances measured on the roof (RO) and the posterior wall (PW) showed a high correspondence between the EA model and CT/MR imaging (RO CT/MR imaging vs. EA: 32 ± 7 vs. 32 ± 7 mm; PW CT/MR imaging vs. EA: 36 ± 6 vs. 36 ± 7 mm). The EA model yielded slightly larger PV ostia diameters, owing to the distortion caused by catheter pressure.
  
  
  CONCLUSIONS
  Recent 3D mapping tools allow outstanding anatomical rendering and are key in complex ablation procedure set-up. This study shows that 3D anatomical reconstruction of LA, PVs, and their variable branches is not only safe and fast but also accurate and reliable.
authors.affiliation: Ospedale Santa Maria del Prato, Via Bagnols sur Cèze 3, Padiglione Dalla Palma, Feltre, BL 32032, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonso
authors.affiliation: Ospedale Santa Maria del Prato, Via Bagnols sur Cèze 3, Padiglione Dalla Palma, Feltre, BL 32032, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Fantinel
authors.affiliation: Ospedale Santa Maria del Prato, Via Bagnols sur Cèze 3, Padiglione Dalla Palma, Feltre, BL 32032, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Scalchi
authors.affiliation: Ospedale Santa Maria del Prato, Via Bagnols sur Cèze 3, Padiglione Dalla Palma, Feltre, BL 32032, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Ferrara
authors.affiliation: St. Jude Medical Italia Spa, Agrate Brianza, MB, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Indiani
authors.affiliation: St. Jude Medical Italia Spa, Agrate Brianza, MB, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Calore
authors.affiliation: St. Jude Medical Italia Spa, Agrate Brianza, MB, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Licciardello
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D000066491:Clinical Decision-Making; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D064847:Multimodal Imaging / Q000379:methods*; D066230:Patient-Specific Modeling; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D014057:Tomography, X-Ray Computed
keywords: 3D imaging; Atrial fibrillation; Catheter ablation; Complex impedance; Electroanatomic mapping