Feasibility of a novel algorithm for automated reconstruction of the left atrial anatomy based on intracardiac echocardiography.

Abstract

Intracardiac echocardiography (ICE) is frequently used to guide electrophysiology procedures. The novel automated algorithm Cartosoundfam is a model-based algorithm which reconstructs a 3D anatomy of the left atrium (LA) based on a set of 2D intracardiac echocardiography (ICE) frames, without the need to manually annotate ultrasound (US) contours. The aim of this study was to determine the feasibility of the Cartosoundfam module in routine clinical setting. We included 16patientsundergoing LA mapping/catheter ablation. Two-dimensional US frames were acquired fromthe right atrium (RA) and the right ventricular outflow tract. The Cartosoundfam map was validatedin two steps:(1)identificationof anatomical structures(pulmonary veins [PV] and LA body and appendage)byalignmentof the ablation catheter to the automated map; and(2) analysis of the automatedlesiontags (Visitag)location in relation to thePV antrum of the Cartosoundfam map inninepatientswith paroxysmal atrial fibrillation (AF)undergoing first time pulmonary vein isolation (PVI). Mean 2D US framesper patient were29±6 andacquisition time was 16±4min.Allanatomical structures were correctly identified inall patients (step 1). In the step 2 validation, the median distance to the map was 2.0 (IQR: 2.4) mm and the majority of the Visitags were classified as satisfactory (69%) but all PV segments had some Visitags classified as unsatisfactory. The automated ICE-based algorithm correctly identified the LA anatomical structures in all patients with a 69% anatomical accuracy of the Visitags alignments to the PV antrum segments.