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Heart Rhythm. 2008 Jul;5(7):957-64. doi: 10.1016/j.hrthm.2008.03.024. Epub 2008 Mar 25.

Biplane three-dimensional augmented fluoroscopy as single navigation tool for ablation of atrial fibrillation: accuracy and clinical value.

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1
Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium, Europe. Joris.Ector@uz.kuleuven.ac.be

Abstract

BACKGROUND:

We developed new methods for real time biplane integration of three-dimensional (3D) left atrial models with fluoroscopic images to assist in catheter ablation of atrial fibrillation (AF).

OBJECTIVE:

The purpose of this study was to quantitatively assess the accuracy of 3D fluoroscopy integration and to evaluate its clinical value when used as a single navigation tool for AF ablation.

METHODS:

Sixty patients underwent AF ablation under biplane fluoroscopic guidance after selective angiography of the four pulmonary veins. Computed tomography [CT]-based 3D models were integrated in the fluoroscopic framework using visual matching and landmark-based registration approaches. Integration accuracy was quantitatively assessed according to registration approach and different CT acquisition parameters (electrocardiogram [ECG] gating, respiratory phase). In 30 of the 60 patients (3D+ group), the integrated 3D model was used for real time 3D-augmented fluoroscopic catheter navigation, and the effects on procedural parameters and patient radiation dose were evaluated.

RESULTS:

Landmark-based registration resulted in superior 3D fluoroscopy integration accuracy compared with the visual matching approach (P <.001 for alignment error and alignment score). The effects of ECG gating and respiratory phase during CT acquisition on integration accuracy were small and clinically irrelevant. The use of 3D-augmented fluoroscopy in the 3D+ group was gauged as extremely helpful by the operator. It resulted in a significant reduction of fluoroscopy time (61 +/- 18 minutes vs. 77 +/- 26 minutes; P = .009) and a trend toward shorter procedure duration (230 +/- 67 minutes vs. 257 +/- 58 minutes; P = .06) versus conventional procedures. The systematic use of nongated cardiac CT in the 3D+ group resulted in an important reduction in total effective patient radiation dose due to CT+fluoroscopy (4 + 14 = 18 +/- 8 mSv vs.17 + 16 = 33 +/- 13 mSv; P <.001).

CONCLUSIONS:

Biplane 3D-augmented fluoroscopy can be used as a safe and accurate stand-alone method to guide AF ablation procedures. The use of nongated cardiac CT substantially reduces total patient radiation dose without a relevant reduction in integration accuracy.

PMID:
18598948
DOI:
10.1016/j.hrthm.2008.03.024
[Indexed for MEDLINE]
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