Real-time integration of intracardiac echocardiography and multislice computed tomography to guide radiofrequency catheter ablation for atrial fibrillation

Abstract

Multislice computed tomography (MSCT) integration is commonly used to guide radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). MSCT provides detailed anatomical information but lacks the ability to provide real-time anatomy during RFCA. Intracardiac echocardiography (ICE) allows real-time visualization of cardiac structures. The purpose of this study was to investigate the feasibility of three-dimensional (3D) anatomical mapping of the left atrium (LA) with ICE and integrating the 3D map with MSCT to facilitate RFCA for AF. In 17 patients undergoing RFCA for AF, 3D mapping of the LA was performed with ICE using a new mapping system that allows tracking of a new ICE probe. On each ICE image, endocardial contours were traced and used to generate a 3D map of the LA and pulmonary veins (PVs). A preprocedurally acquired MSCT image of the LA was then integrated with the 3D map. Additionally, PV assessment with ICE was compared with MSCT. Accurate 3D mapping could be performed in all patients with a mean number of 31.1 +/- 8.5 contours. Integration with MSCT resulted in a mean distance between the MSCT and ICE contours of 2.2 +/- 0.3 mm for the LA and PVs together and of 1.7 +/- 0.2 mm around the PV ostia specifically. Agreement in the assessment of PV anatomy and diameters between ICE and MSCT was excellent. Three-dimensional ICE mapping of the LA is feasible. The 3D map created with ICE can be merged with MSCT to facilitate RFCA for AF.