Abstract 12818: First Experience of Three-dimensional Rotational Angiography Image Integration With Electroanatomical Mapping System to Guide Catheter Ablation of Atrial Fibrillation

Abstract

Introduction: Rotational angiography of the left atrium with three-dimensional (3D) reconstruction (3D-ATG) represents a modern method enabling to create computed tomography (CT) like 3D images on a standard X-ray machine. Recently, electroanatomical mapping system can import 3D images reconstructed by 3D-ATG. Hypothesis: We assessed the hypothesis that atrial fibrillation (AF) ablation using 3D-ATG would be feasible with a significant reduction in effective dose without compromising image quality compared with 3D CT image. Methods: 3D-ATG was performed by using the Philips Allura Xper FD 10 system operated at a low-frame pulsed fluoroscopy (7.5 frames per second). Effective radiation dose was calculated from dose area product (DAP) measurements in 103 patients (mean age of 65 years, 71% men) undergoing AF ablation guided by 3D-ATG. Organ dose was measured at 37 points with a radiophotoluminescence glass dosimeter inserted in the position of an anthropomorphic Rando Phantom. Effective dose was calculated by multiplying organ dose by tissue weighting factor. The DAP to effective dose conversion factor was calculated by measurement of DAP at the same time of radiation exposure. Effective dose at CT examination was estimated from dose length product and conversion factor of 0.014. Left atrial dimensions and vertical ostial pulmonary vein (PV) diameters for each imaging method were compared. Results: The DAP to effective dose conversion factor of 3D-ATG was 2.4x10 -4 mSv/mGy•cm 2 by using the Philips Allura Xper FD 10 system in our hospital. Mean DAP for all patients was 7777±1488mGy•cm 2 for rotational angiography of the left atrium. The corresponding effective radiation doses for 3D-ATG were 1.9±0.4mSv. The effective doses for CT examinations were 13.6±4.2mSv (p<0.001). The correlations of left atrial dimension were r=0.73 for sagittal plane, 0.76 for coronal, and 0.80 for vertical (p<0.005). The correlation coefficient between 3D-ATG and 3D-CT for the ostial PV diameters was r=0.72 for left superior PV, 0.88 for left inferior PV, 0.60 for right superior PV, and 0.65 for right inferior PV (p<0.005). Conclusions: AF ablation using 3D-ATG is possible with a significant reduction in effective dose without compromising image quality.