Image integration into 3-dimensional-electro-anatomical mapping system facilitates safe ablation of ventricular arrhythmias originating from the aortic root and its vicinity

TY - JOUR

T1 - Image integration into 3-dimensional-electro-anatomical mapping system facilitates safe ablation of ventricular arrhythmias originating from the aortic root and its vicinity

AU - Jularic, Mario

AU - Akbulak, Ruken Özge

AU - Schäffer, Benjamin

AU - Moser, Julia

AU - Nuehrich, Jana

AU - Meyer, Christian

AU - Eickholt, Christian

AU - Willems, Stephan

AU - Hoffmann, Boris A

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Aims: During ablation in the vicinity of the coronary arteries establishing a safe distance from the catheter tip to the relevant vessels is mandatory and usually assessed by fluoroscopy alone. The aim of the study was to investigate the feasibility of an image integration module (IIM) for continuous monitoring of the distance of the ablation catheter tip to the main coronary arteries during ablation of ventricular arrhythmias (VA) originating in the sinus of valsalva (SOV) and the left ventricular summit part of which can be reached via the great cardiac vein (GCV).Methods and results: Of 129 patients undergoing mapping for outflow tract arrhythmias from June 2014 till October 2015, a total of 39 patients (52.4 ± 18.1 years, 17 female) had a source of origin in the SOV or the left ventricular summit. Radiofrequency (RF) ablation was performed when a distance of at least 5 mm could be demonstrated with IIM. A safe distance in at least one angiographic plane could be demonstrated in all patients with a source of origin in the SOV, whereas this was not possible in 50% of patients with earliest activation in the summit area. However, using the IIM a safe position at an adjacent site within the GCV could be obtained in three of these cases and successful RF ablation performed safely without any complications. Ablation was successful in 100% of patients with an origin in the SOV, whereas VAs originating from the left ventricular summit could be abolished completely in only 60% of cases.Conclusion: Image integration combining electroanatomical mapping and fluoroscopy allows assessment of the safety of a potential ablation site by continuous real-time monitoring of the spatial relations of the catheter tip to the coronary vessels prior to RF application. It aids ablation in anatomically complex regions like the SOV or the ventricular summit providing biplane angiograms merged into the three-dimensional electroanatomical map.

AB - Aims: During ablation in the vicinity of the coronary arteries establishing a safe distance from the catheter tip to the relevant vessels is mandatory and usually assessed by fluoroscopy alone. The aim of the study was to investigate the feasibility of an image integration module (IIM) for continuous monitoring of the distance of the ablation catheter tip to the main coronary arteries during ablation of ventricular arrhythmias (VA) originating in the sinus of valsalva (SOV) and the left ventricular summit part of which can be reached via the great cardiac vein (GCV).Methods and results: Of 129 patients undergoing mapping for outflow tract arrhythmias from June 2014 till October 2015, a total of 39 patients (52.4 ± 18.1 years, 17 female) had a source of origin in the SOV or the left ventricular summit. Radiofrequency (RF) ablation was performed when a distance of at least 5 mm could be demonstrated with IIM. A safe distance in at least one angiographic plane could be demonstrated in all patients with a source of origin in the SOV, whereas this was not possible in 50% of patients with earliest activation in the summit area. However, using the IIM a safe position at an adjacent site within the GCV could be obtained in three of these cases and successful RF ablation performed safely without any complications. Ablation was successful in 100% of patients with an origin in the SOV, whereas VAs originating from the left ventricular summit could be abolished completely in only 60% of cases.Conclusion: Image integration combining electroanatomical mapping and fluoroscopy allows assessment of the safety of a potential ablation site by continuous real-time monitoring of the spatial relations of the catheter tip to the coronary vessels prior to RF application. It aids ablation in anatomically complex regions like the SOV or the ventricular summit providing biplane angiograms merged into the three-dimensional electroanatomical map.

KW - Action Potentials

KW - Adult

KW - Aged

KW - Arrhythmias, Cardiac/diagnostic imaging

KW - Catheter Ablation/adverse effects

KW - Coronary Angiography/methods

KW - Coronary Vessels/diagnostic imaging

KW - Electrophysiologic Techniques, Cardiac

KW - Feasibility Studies

KW - Female

KW - Fluoroscopy

KW - Heart Rate

KW - Heart Ventricles/diagnostic imaging

KW - Humans

KW - Imaging, Three-Dimensional

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Radiographic Image Interpretation, Computer-Assisted

KW - Risk Factors

KW - Sinus of Valsalva/diagnostic imaging

KW - Treatment Outcome

KW - Ventricular Function, Left

U2 - 10.1093/europace/euw399

DO - 10.1093/europace/euw399

M3 - SCORING: Journal article

C2 - 28340078

VL - 20

SP - 520

EP - 527

JO - EUROPACE

JF - EUROPACE

SN - 1099-5129

IS - 3

ER -