Segmentation of anatomical heart structures in Ensite Verismo software for radiofrequency ablation of arrhythmogenic tissues

Abstract

Review of the problem. The relevance of the research is the need of a high-quality imaging of the left atrium anatomy for the effectiveness of radiofraquency ablation of arrhythmogenic tissue of the myocardium in real time. For its safety it is important to assess the attachment of the esophagus to the wall of the heart. Nowadays, methods of visualization of real anatomical structures are dynamically developed on the basis of data processing of DICOM computer and magnetic resonance imaging, including for the reconstruction of 3D anatomy of the heart. Purpose of research. The task of the research was to construct a three-dimensional model of the anatomical structures of the heart and the nearby organs (pulmonary veins, esophagus) in EnSite Verismo software environment (St.Jude Medical, USA) and to implement the technique in clinical practice in order to improve the accuracy of visualization, safety and efficacy of RFA in X-ray conditions in real time. Metodology. The research was carried out at the M.M. Amosov National Institute of Cardiovascular Surgery Ukraine NAMS of Ukraine with the use of modern specialized high-tech medical equipment and clinical materials, computer tomography images (CT) of the patient's heart N. obtained in the radiation diagnostics department and data of the electroanatomic mapping of the patient's heart in the department of treatment of arrhythmias with X-ray surgery. The approach for conducting RFA with the EnSite Verismo software was implemented using the following algorithm:Receiving and preserving CT scans of the patient in the DICOM format.Downloading gray images into the EnSite Verismo software.Construction of a 3D model of anatomical structures of the heart, pulmonary veins and esophagus by the segmentation of CT images.Export of model to the EnSite NavX system (St. Jude Medical, USA).Combination of a segmented model and electroanatomical map in the EnSite NavX system for further radiofrequency ablation.An algorithm for 3D segmentation of the left atrium, pulmonary veins and esophagus in the EnSite Verismo software is developed. It is based on the threshold method of splitting the image into an area for which a certain homogeneity criterion is fulfilled. Result and conclusions. The developed algorithm for segmentation of the left atrium, pulmonary veins and esophagus for the EnSite Verismo allows for the construction of an exact anatomy of structures. The 3D model of individual anatomy of the heart provides the information for surgeon during RFA about the features of the structure of the left atrium: the location of the pulmonary veins in order to avoid vein stenosis; the localisation of the esophagus in order to apply ablation very carefully, so as not to make the perforation of the esophagus. A 3D model, supplemented by an electro-anatomical map of the left atrium that shows, in addition to anatomy, the order of activation of heart miocardium and localization of arrhythmia, will increase the efficiency and safety of RFA.