Intraprocedural reconstruction of the left atrium and pulmonary veins as a single navigation tool for ablation of atrial fibrillation: A feasibility, efficacy, and safety study

Background

Pulmonary vein (PV) isolation is a technically challenging intervention. For this reason, integration of three-dimensional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) in order to enhance effectiveness and safety has been widely adopted. A novel imaging approach—intraprocedural rotational angiography and reconstruction of the left atrium and PVs—is feasible and provides high anatomic accuracy.

Objective

The purpose of this study was to prove the feasibility, safety, and efficacy of this imaging approach as a single navigation tool for PV isolation.

Methods

Forty-four patients (25 men and 19 women; age 57 ± 11 years) with atrial fibrillation (AF) who presented for PV isolation were studied. Rotational angiography during adenosine-induced ventricular asystole was performed under sedation with propofol. The left atrium and PVs were reconstructed by three-dimensional atriography using specialized software (EP navigator prototype, Philips Medical Systems). Three-dimensional atriography was used as a single navigation tool for guiding PV isolation.

Results

Of 176 PVs, 174 (99%) were isolated. Total procedural and fluoroscopy times were 192 ± 46 minutes and 44 ± 12 minutes, respectively. During follow-up of 6 ± 3 months, 31 (70%) patients were free of symptoms and had no evidence of AF without any antiarrhythmic medication. MRI examination of 41 patients at 3-month follow-up excluded PV stenosis. No major complications occurred.

Conclusion

Three-dimensional atriography is a novel intraprocedural three-dimensional imaging technique that is based on rotational angiography. It can be safely and effectively used as a single navigation tool for performing PV isolation.

Keywords: Atrial fibrillation, Ablation, Imaging, Rotational angiography, Three-dimensional reconstruction