Dynamic registration of preablation imaging with a catheter geometry to guide ablation in a Swine model: validation of image integration and assessment of catheter navigation accuracy.

BACKGROUND: Catheter ablation of atrial and ventricular tachyarrhythmia involves anatomically based cardiac ablation strategies. CT and MRI images provide the most detailed cardiac anatomy available. Integration of these images into a mapping system should produce detailed and accurate models suitable to guide ablation. OBJECTIVE: The purpose of this study was to validate and assess the accuracy of a novel CT and MRI image integration algorithm designed to facilitate catheter navigation and ablation. METHODS: Using a lateral thoracotomy, markers were sutured to the epicardial surface of each cardiac chamber in 12 swine. Detailed CT/MRI anatomy was imported into the mapping system. The CT/MRI image was then integrated with a detailed catheter geometry of the relevant chamber using a new image integration algorithm. The epicardial markers, identified from the CT/MRI images, were then displayed on the surface of the integrated image. Guided only by the integrated CT/MRI, a single RF lesion was directed at the corresponding endocardial site for each epicardial marker. At autopsy, the distance from the endocardial RF lesion to the target site was assessed. RESULTS: The mean position error (CT/MRI) for the left atrium was 2.5 +/- 2.4 mm/5.1 +/- 3.9 mm, for the right atrium 6.2 +/- 6.5 mm/4.3 +/- 2.2 mm, for the right ventricle 6.2 +/- 4.3 mm/6.6 +/- 5.3 mm, and for the left ventricle 4.7 +/- 3.4 mm/3.1 +/- 2.7 mm. There was no cardiac perforation or tamponade. CONCLUSION: CT and MRI images can be effectively utilized for catheter navigation when integrated into a mapping system. This novel registration module with dynamic registration provides effective guidance for ablation.

Validation of computed tomography image integration into the EnSite NavX mapping system to perform catheter ablation of atrial fibrillation.

INTRODUCTION: The complex anatomy of the left atrium (LA) makes location of ablation catheters difficult using fluoroscopy alone, and therefore 3D mapping systems are now routinely used. We describe the integration of a CT image into the EnSite NavX System with Fusion and its validation in patients undergoing atrial fibrillation (AF) or left atrial tachycardia (AT) catheter ablation. METHODS AND RESULTS: Twenty-three patients (61 +/- 9.2 years, 16 male) with paroxysmal (14) and persistent (8) AF and persistent (1) AT underwent ablation using CT image integration into the EnSite NavX mapping system with the EnSite Fusion Dynamic Registration software module. In all cases, segmentation of the CT data was accomplished using the EnSite Verismo segmentation tool, although repeat segmentation attempts were required in seven cases. The CT was registered with the NavX-created geometry using an average of 24 user-defined fiducial pairs (range 9 to 48). The average distance from NavX-measured lesion positions to the CT surface was 3.2 +/- 0.9 mm (median 2.4 mm). A large, automated, retrospective test using registrations with random subsets of each patient's fiducial pairs showed this average distance decreasing as the number of fiducial pairs increased, although the improvement ceased to be significant beyond 15 pairs. In confirmation, those studies which had used 16 or more pairs had a smaller average lesion-to-surface distance (2.9 +/- 0.7 mm) than those using 15 or fewer (4.3 +/- 0.8 mm, P < 0.02). Finally, for the 13 patients who underwent left atrial circumferential ablation (LACA), there was no significant difference between the circumference computed using NavX-measured positions and CT surface positions for either the left pulmonary veins (178 +/- 64 vs. 177 +/- 60 mm; P = 0.81) or the right pulmonary veins (218 +/- 86 vs. 207 +/- 81 mm; P = 0.08). CONCLUSION: CT image integration into the EnSite NavX Fusion system was successful in all patients undergoing catheter ablation. A learning curve exists for the Verismo segmentation tool; but once the 3D model was created, the registration process was easily accomplished, with a registration error that is comparable with registration errors using other mapping systems with CT image integration. All patients went on to have subsequent successful ablation procedures. Where LACA was performed (13 patients), only four patients required segmental ostial lesions to achieve electrical isolation.