Three‐Dimensional Image Integration: A First Experience with Guidance of Atrial Fibrillation Ablations

Abstract

Editorial Comment The treatment of atrial fibrillation (AF) can be challenging, with a rate control strategy not being optimal for all patients and antiarrhythmic drugs frequently ineffective and possessing serious adverse effects. A fluoroscopic or electroanatomic catheter-based approach is rapidly becoming one of the preferred treatments of AF. 1-3 However, success rates are still not ideal and complications due to damage of extra thoracic structures remain a problem. 1 Also of concern is the significant ionizing radiation exposure during the prolonged fluoroscopy required to delineate the complex anatomy of the left atrium and pulmonary veins, even with advanced techniques to minimize exposure. Total fluoroscopy duration for AF ablations is typically 8-fold higher than atrioventricular nodal reentrant tachycardia ablations, averaging over 60 minutes of fluoroscopy time, with radiation exposure in the 1.0‐1.5 Gy range. 4 One of the major promises of using integratedmodality navigation systems such as this for AF ablation is faster, more accurate catheter navigation, reduced complications, and diminished fluoroscopy use. In view of the complex and variable anatomy of cardiac structures and pulmonary veins, many of which remain invisible to fluoroscopy, the addition of further, more accurate imaging modalities are likely to improve ablation success and safety. 5,6 While three-dimensional (3D) mapping techniques using magnetic or electrical localizing systems in the modern electrophysiology laboratory are extremely useful and are currently in widespread clinical use, they require catheter manipulation to identify geometry and do not provide independent anatomic information. Both magnetic resonance (MR) imaging 7,8 and computed tomography (CT) scanning 9,10 have been shown prior to be suitable for delineating the left atrial anatomy and assisting with catheter navigation. However, it is not yet clear which imaging modality is superior for mapping of the left atrium and other cardiac structures; certainly navigation and imaging systems that allow the use of either format will be advantageous.