Cardiac CT imaging used in conjunction with a non-fluoroscopic navigation system (NavX) for atrial fibrillation ablation

Abstract

Case: A 55 year old man with paroxysmal AF was referred to our center for catheter ablation of AF. Cardiac CT imaging with a 64-slice scanner was performed 1 week before the procedure. The raw imaging data was processed using proprietary software (Endocardial Solutions, MN) in order to precisely define the anatomic relationship of the left atrium, pulmonary veins, and esophagus. On the day of the procedure, the processed CT image was imported into the NavX navigation system and was used in conjunction with a NavX-generated geometric map [Figure] to guide circumferential ablation around the right and left pulmonary veins. Ablation was performed using an 8-mm tip ablation catheter, and microbubble monitoring was done with intracardiac ultrasound. Careful attention was paid to avoid ablation within the pulmonary veins, as well as near the esophago-atrial interface. Segmental ostial ablation guided by a 10-pole circular mapping catheter was then performed after circumferential ablation to ensure electrical isolation of each vein. There were no complications. At 6 months, the patient has remained free of AF as assessed by symptoms and periodic Holter monitoring.