Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations

Jun Dong, Hugh Calkins, Stephen B. Solomon, Shenghan Lai, Darshan Dalal, Al Lardo, Erez Brem, Assaf Preiss, Ronald D Berger, Henry R Halperin, Timm Dickfeld

Research output: Contribution to journalArticle

Abstract

Background - New ablation strategies for atrial fibrillation or nonidiopathic ventricular tachycardia are increasingly based on anatomic consideration and require the placement of ablation lesions at the correct anatomic locations. This study sought to evaluate the accuracy of the first clinically available image integration system for catheter ablation on 3-dimensional (3D) computed tomography (CT) images in real time. Methods and Results - After midline sternotomy, 2.3-mm CT fiducial markers were attached to the epicardial surface of each cardiac chamber in 9 mongrel dogs. Detailed 3D cardiac anatomy was reconstructed from contrast-enhanced, high-resolution CT images and registered to the electroanatomic maps of each cardiac chamber. To assess accuracy, targeted ablations were performed at each of the fiducial markers guided only by the reconstructed 3D images. At autopsy, the position error was 1.9±0.9 mm for the right atrium, 2.7±1.2 mm for the right ventricle, 1.8±1.0 mm for the left atrium, and 2.3±1.1 mm for the left ventricle. To evaluate the system's guidance of more complex clinical ablation strategies, ablations of the cavotricuspid isthmus (n=4), fossa ovalis (n=4), and pulmonary veins (n=6) were performed, which resulted in position errors of 1.8± 1.5, 2.2±1.3, and 2.1±1.2 mm, respectively. Retrospective analysis revealed that a combination of landmark registration and the target chamber surface registration resulted in

Original languageEnglish (US)
Pages (from-to)186-194
Number of pages9
JournalCirculation
Volume113
Issue number2
DOIs
StatePublished - Jan 2006

Fingerprint

Fiducial Markers
Tomography
Heart Atria
Heart Ventricles
Systems Integration
Sternotomy
Catheter Ablation
Pulmonary Veins
Ventricular Tachycardia
Atrial Fibrillation
Autopsy
Anatomy
Dogs

Keywords

  • Catheter ablation
  • Electrophysiology
  • Imaging
  • Mapping

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations. / Dong, Jun; Calkins, Hugh; Solomon, Stephen B.; Lai, Shenghan; Dalal, Darshan; Lardo, Al; Brem, Erez; Preiss, Assaf; Berger, Ronald D; Halperin, Henry R; Dickfeld, Timm.

In: Circulation, Vol. 113, No. 2, 01.2006, p. 186-194.

Research output: Contribution to journalArticle

Dong, Jun ; Calkins, Hugh ; Solomon, Stephen B. ; Lai, Shenghan ; Dalal, Darshan ; Lardo, Al ; Brem, Erez ; Preiss, Assaf ; Berger, Ronald D ; Halperin, Henry R ; Dickfeld, Timm. / Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations. In: Circulation. 2006 ; Vol. 113, No. 2. pp. 186-194.
@article{db9aae77994a4de389e942e1aad3539f,
title = "Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations",
abstract = "Background - New ablation strategies for atrial fibrillation or nonidiopathic ventricular tachycardia are increasingly based on anatomic consideration and require the placement of ablation lesions at the correct anatomic locations. This study sought to evaluate the accuracy of the first clinically available image integration system for catheter ablation on 3-dimensional (3D) computed tomography (CT) images in real time. Methods and Results - After midline sternotomy, 2.3-mm CT fiducial markers were attached to the epicardial surface of each cardiac chamber in 9 mongrel dogs. Detailed 3D cardiac anatomy was reconstructed from contrast-enhanced, high-resolution CT images and registered to the electroanatomic maps of each cardiac chamber. To assess accuracy, targeted ablations were performed at each of the fiducial markers guided only by the reconstructed 3D images. At autopsy, the position error was 1.9±0.9 mm for the right atrium, 2.7±1.2 mm for the right ventricle, 1.8±1.0 mm for the left atrium, and 2.3±1.1 mm for the left ventricle. To evaluate the system's guidance of more complex clinical ablation strategies, ablations of the cavotricuspid isthmus (n=4), fossa ovalis (n=4), and pulmonary veins (n=6) were performed, which resulted in position errors of 1.8± 1.5, 2.2±1.3, and 2.1±1.2 mm, respectively. Retrospective analysis revealed that a combination of landmark registration and the target chamber surface registration resulted in",
keywords = "Catheter ablation, Electrophysiology, Imaging, Mapping",
author = "Jun Dong and Hugh Calkins and Solomon, {Stephen B.} and Shenghan Lai and Darshan Dalal and Al Lardo and Erez Brem and Assaf Preiss and Berger, {Ronald D} and Halperin, {Henry R} and Timm Dickfeld",
year = "2006",
month = "1",
doi = "10.1161/CIRCULATIONAHA.105.565200",
language = "English (US)",
volume = "113",
pages = "186--194",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations

AU - Dong, Jun

AU - Calkins, Hugh

AU - Solomon, Stephen B.

AU - Lai, Shenghan

AU - Dalal, Darshan

AU - Lardo, Al

AU - Brem, Erez

AU - Preiss, Assaf

AU - Berger, Ronald D

AU - Halperin, Henry R

AU - Dickfeld, Timm

PY - 2006/1

Y1 - 2006/1

N2 - Background - New ablation strategies for atrial fibrillation or nonidiopathic ventricular tachycardia are increasingly based on anatomic consideration and require the placement of ablation lesions at the correct anatomic locations. This study sought to evaluate the accuracy of the first clinically available image integration system for catheter ablation on 3-dimensional (3D) computed tomography (CT) images in real time. Methods and Results - After midline sternotomy, 2.3-mm CT fiducial markers were attached to the epicardial surface of each cardiac chamber in 9 mongrel dogs. Detailed 3D cardiac anatomy was reconstructed from contrast-enhanced, high-resolution CT images and registered to the electroanatomic maps of each cardiac chamber. To assess accuracy, targeted ablations were performed at each of the fiducial markers guided only by the reconstructed 3D images. At autopsy, the position error was 1.9±0.9 mm for the right atrium, 2.7±1.2 mm for the right ventricle, 1.8±1.0 mm for the left atrium, and 2.3±1.1 mm for the left ventricle. To evaluate the system's guidance of more complex clinical ablation strategies, ablations of the cavotricuspid isthmus (n=4), fossa ovalis (n=4), and pulmonary veins (n=6) were performed, which resulted in position errors of 1.8± 1.5, 2.2±1.3, and 2.1±1.2 mm, respectively. Retrospective analysis revealed that a combination of landmark registration and the target chamber surface registration resulted in

AB - Background - New ablation strategies for atrial fibrillation or nonidiopathic ventricular tachycardia are increasingly based on anatomic consideration and require the placement of ablation lesions at the correct anatomic locations. This study sought to evaluate the accuracy of the first clinically available image integration system for catheter ablation on 3-dimensional (3D) computed tomography (CT) images in real time. Methods and Results - After midline sternotomy, 2.3-mm CT fiducial markers were attached to the epicardial surface of each cardiac chamber in 9 mongrel dogs. Detailed 3D cardiac anatomy was reconstructed from contrast-enhanced, high-resolution CT images and registered to the electroanatomic maps of each cardiac chamber. To assess accuracy, targeted ablations were performed at each of the fiducial markers guided only by the reconstructed 3D images. At autopsy, the position error was 1.9±0.9 mm for the right atrium, 2.7±1.2 mm for the right ventricle, 1.8±1.0 mm for the left atrium, and 2.3±1.1 mm for the left ventricle. To evaluate the system's guidance of more complex clinical ablation strategies, ablations of the cavotricuspid isthmus (n=4), fossa ovalis (n=4), and pulmonary veins (n=6) were performed, which resulted in position errors of 1.8± 1.5, 2.2±1.3, and 2.1±1.2 mm, respectively. Retrospective analysis revealed that a combination of landmark registration and the target chamber surface registration resulted in

KW - Catheter ablation

KW - Electrophysiology

KW - Imaging

KW - Mapping

UR - http://www.scopus.com/inward/record.url?scp=33645010220&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33645010220&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.105.565200

DO - 10.1161/CIRCULATIONAHA.105.565200

M3 - Article

C2 - 16401772

AN - SCOPUS:33645010220

VL - 113

SP - 186

EP - 194

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 2

ER -