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
Received 11 January 2009; accepted 20 February 2009. published online 02 March 2009.
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.
⁎Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
†Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
Address reprint requests and correspondence: Dr. Charalampos Kriatselis, Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Dr. Kriatselis has received speaker honoraria from Philips, The Netherlands. Dr. M. Tang received a grant from the Kaiserin-Friedrich-Stiftung.
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