Abstract
Introduction: Catheter ablation of cardiac arrhythmias requires accurate navigation of a catheter in the heart. Biplane fluoroscopy is expensive and significantly increases radiation exposure. Single-plane fluoroscopy, although available in all interventional laboratories, does not provide three-dimensional (3D) catheter visualization. Thus, in a typical X-ray image seen during ablation, it is only possible to view the x-y axes; the actual depth of the cardiac catheter is not discernible. Hypothesis: We tested whether a set of digital image processing techniques and mathematical algorithms (APN Algorithm) could accurately construct 3D spatial orientation of an ablation catheter from single-plane fluoroscopy. Methods: Algorithms were designed to automatically determine 3D position and orientation of a radio-opaque mapping and ablation catheter using single-plane fluoroscopy only. Design consisted of: 1) capturing a stream of digital images from a single-plane fluoroscope; 2) detecting the image of the catheter in a subset of fluoroscopic images; and 3) applying pixel-level geometric calculations to the catheter image. The algorithms further included identifying the edges of the catheter at a subpixel level and determining the x-y-z location of the catheter. The 3D location of the catheter tip using single-plane images alone was then compared with 3D location as determined by two current gold standards: a 3D magnetic navigation system (CARTO, Biosense Webster Inc., Diamond Bar, CA), and biplane images taken in back projection technique (Ground Truth). Results: In a hexagonal phantom model (see figure), APN Algorithm revealed catheter location within 0.99 mm of Ground Truth. Conclusion: It is possible to determine the exact location of ablation catheters in three dimensions from single-plane fluoroscopic images without the need for biplane fluoroscopy. This approach could be extended to create 3D maps for catheter navigation and ablation.
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