Integration of Imaging: Impact on Outcome of AF Ablation
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Transcript of Integration of Imaging: Impact on Outcome of AF Ablation
Integration of Imaging:Impact on Outcome of AF Ablation
Ahmed Abdelaal, MD
CHU Nancy, France
CAIROSTIM NOV 2008
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Pulmonary vein fociHaïssaguerre M, N Engl J Med 1998;339:659-66
Marshall ligamentHwang C, Circulation 2000;101:1503-5
RotorMandapati R, Circulation 2000;101:194-
99
Cardiac innervationSchauerte P, Circulation 2000;102:2274-
80
Coronary sinusSuperior vena cava Right atrial foci ...
AF: from mechanisms to targets
By courtesy- Christian de Chillou
Left atrium- PV anatomy
LSPV - LAA junction
Common vestibule for both
LPV
4 PV> OR <4 PV77%
20%
23%
Left atrium- PV Imaging
Left atrium- PV Imaging
ICE: 2/6 RPV (33%)
-Venography overestimates PV ostial diamaters- TEE underestimates PV ostial diamaters-ICE is correlated to CT ostial diamaters
Image integration: from real to virtual anatomy
3-D Image integration: back to real anatomy
3-D Image integration: back to real anatomy
3-D Image integration: back to real anatomy
(1) Best landmark registration could be achieved at posterior LA-PV junctions
3-D Image integration: back to real anatomy
(2) Significant landmark shift after surface registration
- Positively correlated to surface registration error
- Surface registration errors were more evident for RPVs
3-D Image integration: back to real life
(1) The effect of respiration:
-Classic splaying effect of PV- Minimal at LA junction
-Maximum at distal PV and MA area
Ector et al, JCE 2008
3-D Image integration: back to real life
(2) The effect of cardiac rhythm:
Patel et al, JICE 2008
3-D Image integration: back to real life
(3) The effect of cardiac rhythm:
Patel et al, JICE 2008
3-D Image integration: back to real life
(2) The effect of cardiac cycle:
Sra el et al, JICE 2008
The need for 3-D image integration
The need for 3-D image integration
10+/-5mm
Superimposed+/-5mm
The need for 3-D image integration
The need for 3-D image integration
The final impact of 3-D image integration on outcome of AF
ablation
StudyStudy No of ptsNo of pts XRTXRT FOLLOW UPFOLLOW UP SUCCESSSUCCESS
Kistler et al Kistler et al 20062006
9494 49 vs 49 vs 6262
25 weeks25 weeks 78 vs 48 %78 vs 48 %
Kai etal 2008Kai etal 2008 8181 99 vs 99 vs 2929
6m6m 78 vs 74 %78 vs 74 %
Kistler etal Kistler etal 20082008
8080 22 22 vs41vs41
6m6m 56 vs 50 %56 vs 50 %
Conclusions
1. PV isolation is still the corner stone in the ablation of atrial fibrillation.
2. Different Cardiac imaging modalities are important for precise delineation of important LA anatomical structures crucial for safe and effective ablation.
3. The use of 3D image integration could be a useful tool taking into consideration its potential limitations during the mapping procedure.
Stanislas Square - Nancy