A. Maruyama is an employee of Biosense Webster. Other authors: No disclosures.
Effect of Catheter Tip-Tissue Surface Contact on Three-Dimensional Left Atrial and Pulmonary Vein Geometries: Potential Anatomic Distortion of 3D Ultrasound, Fast Anatomical Mapping, and Merged 3D CT-Derived Images
Version of Record online: 21 DEC 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 3, pages 259–266, March 2013
How to Cite
OKUMURA, Y., WATANABE, I., KOFUNE, M., NAGASHIMA, K., SONODA, K., MANO, H., OHKUBO, K., NAKAI, T., SASAKI, N., KOGAWA, R., MARUYAMA, A. and HIRAYAMA, A. (2013), Effect of Catheter Tip-Tissue Surface Contact on Three-Dimensional Left Atrial and Pulmonary Vein Geometries: Potential Anatomic Distortion of 3D Ultrasound, Fast Anatomical Mapping, and Merged 3D CT-Derived Images. Journal of Cardiovascular Electrophysiology, 24: 259–266. doi: 10.1111/jce.12062
- Issue online: 4 MAR 2013
- Version of Record online: 21 DEC 2012
- Accepted manuscript online: 21 NOV 2012 04:03PM EST
- Manuscript received 22 July 2012; Revised manuscript received 26 September 2012; Accepted for publication 9 October 2012.
- 3D ultrasound mapping;
- anatomic distortion;
- atrial fibrillation;
- catheter ablation;
- contact force sensing;
- electroanatomic mapping
Anatomic Distortion of 3D Mapping. Background: Although catheter tip-tissue contact is known as a reliable basis for mapping and ablation of atrial fibrillation (AF), the effects of different mapping methods on 3-dimensional (3D) map configuration remain unknown.
Methods and Results: Twenty AF patients underwent Carto-based 3D ultrasound (US) evaluation. Left atrium (LA)/pulmonary vein (PV) geometry was constructed with the 3D US system. The resulting geometry was compared to geometries created with a fast electroanatomical mapping (FAM) algorithm and 3D US merged with computed tomography (merged 3D US-CT). The 3D US-derived LA volumes were smaller than the FAM- and merged 3D US-CT-derived volumes (75 ± 21 cm3 vs 120 ± 20 cm3 and 125 ± 25 cm3, P < 0.0001 for both). Differences in anatomic PV orifice fiducials between 3D US- and FAM- and merged 3D US-CT-derived geometries were 6.0 (interquartile range 0–9.3) mm and 4.1 (0–7.0) mm, respectively. Extensive encircling PV isolation guided by 3D US images with real-time 2D intracardiac echocardiography-based visualization of catheter tip-tissue contact generated ablation point (n = 983) drop-out at 1.9 ± 3.8 mm beyond the surface of the 3D US-derived LA/PV geometry. However, these same points were located 1.5 ± 5.4 and 0.4 ± 4.1 mm below the FAM- and merged 3D US-CT-derived surfaces.
Conclusions: Different mapping methods yield different 3D geometries. When AF ablation is guided by 3D US-derived images, ablation points fall beyond the 3D US surface but below the FAM- or merged 3D US-CT-derived surface. Our data reveal anatomic distortion of 3D images, providing important information for improving the safety and efficacy of 3D mapping-guided AF ablation. (J Cardiovasc Electrophysiol, Vol. 24, pp. 259-266, March 2013)