Semi-automated 3-dimensional intracardiac echocardiography: Development and initial clinical experience of a new system to guide ablation procedures

Knackstedt, Christian; Franke, Andreas; Mischke, Karl; Zarse, Markus; Gramley, Felix; Schimpf, Thomas; Plisiene, Jurgita; Muehlenbruch, Georg; Spuentrup, Elmar; Ernst, Sabine; Willems, Stephan; Kirchhof, Paulus; Schauerte, Patrick

doi:10.1016/j.hrthm.2006.05.026

« Previous Next »Heart Rhythm
Volume 3, Issue 12 , Pages 1453-1459, December 2006

Semi-automated 3-dimensional intracardiac echocardiography: Development and initial clinical experience of a new system to guide ablation procedures

Christian Knackstedt, MD
- Department of Cardiology, RWTH University Aachen, Aachen, Germany
Andreas Franke, MD
- Department of Cardiology, RWTH University Aachen, Aachen, Germany
Karl Mischke, MD
- Department of Cardiology, RWTH University Aachen, Aachen, Germany
Markus Zarse, MD
- Department of Cardiology, RWTH University Aachen, Aachen, Germany
Felix Gramley, MD
- Department of Cardiology, RWTH University Aachen, Aachen, Germany
Thomas Schimpf, MD
- Department of Cardiology, RWTH University Aachen, Aachen, Germany
Jurgita Plisiene, MD
- Department of Cardiology, RWTH University Aachen, Aachen, Germany
Georg Muehlenbruch, MD
- Department of Radiology, RWTH University Aachen, Aachen, Germany
Elmar Spuentrup, MD
- Department of Radiology, RWTH University Aachen, Aachen, Germany
Sabine Ernst, MD
- Department of Cardiology, Allgemeines Krankenhaus St. Georg, Hamburg, Germany
Stephan Willems, MD
- Department of Cardiology, University Hospital Eppendorf, Hamburg, Germany
Paulus Kirchhof, MD
- Dept. of Cardiology and Angiology, Hospital of the University of Muenster, Germany.
Patrick Schauerte, MD
- Department of Cardiology, RWTH University Aachen, Aachen, Germany
- Address reprint requests and correspondence: Patrick Schauerte, MD, RWTH University Aachen, Department of Cardiology, Pauwelsstrasse 30, 52074 Aachen, Germany.

Received 2 November 2005; accepted 19 May 2006. published online 16 June 2006.

Background

Pre-interventional three-dimensional (3D) reconstruction of the heart by CT or MRI provides important information on cardiac anatomy for electrophysiological interventions. However, updates of 3D-imaging modalities with high soft-tissue contrast are not available during ablation procedures.

Objective

We describe the development and first clinical testing of a close to real-time visualization of cardiac anatomy by intracardiac echocardiography (ICE).

Methods

An electronic phased-array 5–10 MHz ICE-catheter (AcuNav^™/Siemens/64 elements) was inserted via a straightened femoral vein sheath (12F) and placed in the right atrium in 5 pigs. A custom-made prototype stepper motor allowed automatic rotation around the longitudinal axis from 90° to 360° in 2–5° steps. For every plane 2D images of a complete cardiac cycle were acquired, triggered by respiration and ECG. The ultrasound images were digitized and 3D-reconstruction was performed by a prototype software. After experimental validation the system was tested in 6 patients during electrophysiological studies.

Results

From a single location in the right atrium, 3D-acquisition and reconstruction of both atria and ventricles with good image quality were achieved within 3–5 minutes. Doppler-mode facilitated identification of the great vessels including the pulmonary veins and their entry into the heart. 3D-visualization of ablation catheters was also possible in all patients and pigs.

Conclusion

Semi-automated 3D intracardiac echocardiography from a single site inside the right atrium provides the electrophysiologist with a detailed image of both atria and ventricles with repeated updates of the cardiac anatomy.

Keywords: Intracardiac echocardiography, Three-dimensional imaging of the heart, Catheter ablation