Skip to main content
SpringerLink
Log in

3D X-ray imaging methods in support catheter ablations of cardiac arrhythmias

  • Review Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Cardiac arrhythmias are a very frequent illness. Pharmacotherapy is not very effective in persistent arrhythmias and brings along a number of risks. Catheter ablation has became an effective and curative treatment method over the past 20 years. To support complex arrhythmia ablations, the 3D X-ray cardiac cavities imaging is used, most frequently the 3D reconstruction of CT images. The 3D cardiac rotational angiography (3DRA) represents a modern method enabling to create CT like 3D images on a standard X-ray machine equipped with special software. Its advantage lies in the possibility to obtain images during the procedure, decreased radiation dose and reduction of amount of the contrast agent. The left atrium model is the one most frequently used for complex atrial arrhythmia ablations, particularly for atrial fibrillation. CT data allow for creation and segmentation of 3D models of all cardiac cavities. Recently, a research has been made proving the use of 3DRA to create 3D models of other cardiac (right ventricle, left ventricle, aorta) and non-cardiac structures (oesophagus). They can be used during catheter ablation of complex arrhythmias to improve orientation during the construction of 3D electroanatomic maps, directly fused with 3D electroanatomic systems and/or fused with fluoroscopy. An intensive development in the 3D model creation and use has taken place over the past years and they became routinely used during catheter ablations of arrhythmias, mainly atrial fibrillation ablation procedures. Further development may be anticipated in the future in both the creation and use of these models.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Blomstrom-Lundqvist C, Scheinman MM, Aliot EM et al (2003) ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology. J Am Coll Cardiol 42(8):1493–1531

    Article  PubMed  Google Scholar 

  2. Calkins H, Kuck KH, Cappato R et al (2012) HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 33(2):171–257

    Article  PubMed  Google Scholar 

  3. Zipes DP, Camm AJ, Borggrefe M et al (2006) ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. A report of the American college of cardiology/American heart association task force and the European society of cardiology com. Europace 8(9):746–837

    Article  PubMed  Google Scholar 

  4. Vaughan Williams EM (1984) A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol 24(4):129–147

    Article  PubMed  CAS  Google Scholar 

  5. Gosselink AT, Crijns HJ, Van Gelder IC et al (1992) Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. JAMA 267(24):3289–3293

    Article  PubMed  CAS  Google Scholar 

  6. Kerin NZ, Faitel K, Kerin IA et al (2000) Efficacy of low-dose amiodarone in the prevention of paroxysmal atrial fibrillation resistant to type IA antiarrhythmic drugs. Am J Ther 7(4):245–250

    Article  PubMed  CAS  Google Scholar 

  7. Rogers WJ, Epstein AE, Arciniegas JG et al (1989) Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. The cardiac arrhythmia suppression trial (CAST) investigators. N Engl J Med 321(6):406–412

    Article  Google Scholar 

  8. Rogers WJ, Epstein AE, Arciniegas JG et al (1992) Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. The cardiac arrhythmia suppression Trial II investigators. N Engl J Med 327(4):227–33

  9. Purkinje JE (1845) Mikroskopisch-neurologische beobachtungen. Arch Anat Physiol Wiss Med II/III:281–295

    Google Scholar 

  10. His W Jr (1893) Die Tätigkeit des embryonalen Herzens und deren Bedeutung für die Lehre von der Herzbewegung beim Erwachsenen. Arb Med Klin 1:14–49

  11. Keith A, Flack M (1907) The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41(Pt 3):172–189

    PubMed  CAS  PubMed Central  Google Scholar 

  12. Aschoff L, Tawara S (1906) Die heutige Lehre von den pathologisch-anatomischen Grundlagen der Herzschwäche. Kritische Bemerkungen auf Grund eigener Untersuchungen. Jena Gust Fischer

  13. Scherlag BJ, Lau SH, Helfant RH et al (1969) Catheter technique for recording his bundle activity in man. Circulation 39(1):13–18

    Article  PubMed  CAS  Google Scholar 

  14. Gallagher JJ, Svenson RH, Kasell JH et al (1982) Catheter technique for closed-chest ablation of the atrioventricular conduction system. N Engl J Med 306(4):194–200

    Article  PubMed  CAS  Google Scholar 

  15. Borggrefe M, Budde T, Podczeck A et al (1987) High frequency alternating current ablation of an accessory pathway in humans. J Am Coll Cardiol 10(3):576–582

    Article  PubMed  CAS  Google Scholar 

  16. Wittkampf FH (1992) Temperature response in radiofrequency catheter ablation. Circulation 86(5):1648–1650

    Article  PubMed  CAS  Google Scholar 

  17. Calkins H, Epstein A, Packer D et al (2000) Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: results of a prospective multicenter study. Cooled RF multi center investigators group. J Am Coll Cardiol 35(7):1905–1914

    Article  PubMed  CAS  Google Scholar 

  18. Cappato R, Calkins H, Chen SA et al (2010) Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 3(1):32–38

    Article  PubMed  Google Scholar 

  19. Verma A, Natale A (2005) Should atrial fibrillation ablation be considered first-line therapy for some patients? Why atrial fibrillation ablation should be considered first-line therapy for some patients. Circulation 112(8):1214–1222

    Article  PubMed  Google Scholar 

  20. Pappone C, Rosanio S, Augello G et al (2003) Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 42(2):185–197

    Article  PubMed  Google Scholar 

  21. Gepstein L, Hayam G, Ben-Haim SA (1997) A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation 95(6):1611–1622

    Article  PubMed  CAS  Google Scholar 

  22. Jongbloed MR, Bax JJ, Lamb HJ et al (2005) Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation: a head-to-head comparison. J Am Coll Cardiol 45(3):343–350

    Article  PubMed  Google Scholar 

  23. Kato R, Lickfett L, Meininger G et al (2003) Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation 107(15):2004–2010

    Article  PubMed  Google Scholar 

  24. Ohnesorge B, Flohr T, Becker C et al (2000) Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. Radiology 217(2):564–571

    Article  PubMed  CAS  Google Scholar 

  25. de Feyter PJ, Krestin GP (eds) (2005) Computed tomography of the coronary arteries, 1st edn. Taylor & Francis Group, Abingdon

    Google Scholar 

  26. Yamamuro M, Tadamura E, Kubo S et al (2005) Cardiac functional analysis with multi-detector row CT and segmental reconstruction algorithm: comparison with echocardiography, SPECT, and MR imaging. Radiology 234(2):381–390

    Article  PubMed  Google Scholar 

  27. Feuchtner GM, Dichtl W, Friedrich GJ et al (2006) Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity. J Am Coll Cardiol 47(7):1410–1417

    Article  PubMed  Google Scholar 

  28. Ou P, Celermajer DS, Calcagni G et al (2007) Three-dimensional CT scanning: a new diagnostic modality in congenital heart disease. Heart 93(8):908–913

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kim JS, Kim HH, Yoon Y (2007) Imaging of pericardial diseases. Clin Radiol 62(7):626–631

    Article  PubMed  CAS  Google Scholar 

  30. Thiagalingam A, Manzke R, D’Avila A et al (2008) Intraprocedural volume imaging of the left atrium and pulmonary veins with rotational X-ray angiography: implications for catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 19(3):293–300

    Article  PubMed  Google Scholar 

  31. Kriatselis C, Tang M, Nedios S et al (2009) Intraprocedural reconstruction of the left atrium and pulmonary veins as a single navigation tool for ablation of atrial fibrillation: a feasibility, efficacy, and safety study. Heart Rhythm 6(6):733–741

    Article  PubMed  Google Scholar 

  32. De Potter, T (2011) Rotational angiography in repeat atrial fibrillation ablation. GE Healthcare. http://www3.gehealthcare.com/en/Specialties/~/media/Downloads/us/Specialties/Electrophysiology/GEHC-CaseStudy_EP-Innova-3D-Enables-Clinical-Confidence.pdf

  33. Li JH, Haim M, Movassaghi B et al (2009) Segmentation and registration of three-dimensional rotational angiogram on live fluoroscopy to guide atrial fibrillation ablation: a new online imaging tool. Heart Rhythm 6(2):231–237

    Article  PubMed  Google Scholar 

  34. Lehar F, Starek Z, Jez J et al (2013) Rotational atriography of left atrium—a new imaging technique used to support left atrial radiofrequency ablation. Interv Akut Kardiol 12(4):184–189

    Google Scholar 

  35. Tang M, Kriatselis C, Ye G et al (2009) Reconstructing and registering three-dimensional rotational angiogram of left atrium during ablation of atrial fibrillation. Pacing Clin Electrophysiol 32(11):1407–1416

    Article  PubMed  Google Scholar 

  36. Kriatselis C, Tang M, Roser M et al (2009) A new approach for contrast-enhanced X-ray imaging of the left atrium and pulmonary veins for atrial fibrillation ablation: rotational angiography during adenosine-induced asystole. Europace 11(1):35–41

    Article  PubMed  Google Scholar 

  37. Kistler PM, Earley MJ, Harris S et al (2006) Validation of three-dimensional cardiac image integration: use of integrated CT image into electroanatomic mapping system to perform catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17(4):341–348

    Article  PubMed  Google Scholar 

  38. Malchano ZJ, Neuzil P, Cury RC et al (2006) Integration of cardiac CT/MR imaging with three-dimensional electroanatomical mapping to guide catheter manipulation in the left atrium: implications for catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17(11):1221–1229

    Article  PubMed  Google Scholar 

  39. Martinek M, Nesser HJ, Aichinger J et al (2007) Impact of integration of multislice computed tomography imaging into three-dimensional electroanatomic mapping on clinical outcomes, safety, and efficacy using radiofrequency ablation for atrial fibrillation. Pacing Clin Electrophysiol 30(10):1215–1223

    Article  PubMed  Google Scholar 

  40. Knecht S, Wright M, Akrivakis S et al (2010) Prospective randomized comparison between the conventional electroanatomical system and three-dimensional rotational angiography during catheter ablation for atrial fibrillation. Heart Rhythm 7(4):459–465

    Article  PubMed  Google Scholar 

  41. Orlov MV, Jais P, O’Neill M et al (2010) First experience with ElectroNav: combining anatomy and electrograms for AF ablation. Heart Rhythm 7(Suppl):328–329

    Google Scholar 

  42. Orlov MV, Ansari MM, Akrivakis ST et al (2011) First experience with rotational angiography of the right ventricle to guide ventricular tachycardia ablation. Heart Rhythm 8(2):207–211

    Article  PubMed  Google Scholar 

  43. Orlov MV, Hoffmeister P, Chaudhry GM et al (2007) Three-dimensional rotational angiography of the left atrium and esophagus—a virtual computed tomography scan in the electrophysiology lab? Heart Rhythm 4(1):37–43

    Article  PubMed  Google Scholar 

  44. Andreu D, Berruezo A, Ortiz-Pérez JT et al (2011) Integration of 3D electroanatomic maps and magnetic resonance scar characterization into the navigation system to guide ventricular tachycardia ablation. Circ Arrhythm Electrophysiol 4(5):674–683

    Article  PubMed  Google Scholar 

  45. Oakes RS, Badger TJ, Kholmovski EG et al (2009) Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation 119(13):1758–1767

    Article  PubMed  PubMed Central  Google Scholar 

  46. McGann CJ, Kholmovski EG, Oakes RS et al (2008) New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. J Am Coll Cardiol 52(15):1263–1271

    Article  PubMed  Google Scholar 

  47. Tian J, Jeudy J, Smith MF et al (2010) Three-dimensional contrast-enhanced multidetector CT for anatomic, dynamic, and perfusion characterization of abnormal myocardium to guide ventricular tachycardia ablations. Circ Arrhythm Electrophysiol 3(5):496–504

    Article  PubMed  Google Scholar 

  48. Girard EE, Al-Ahmad A, Rosenberg J et al (2011) Contrast-enhanced C-arm CT evaluation of radiofrequency ablation lesions in the left ventricle. JACC Cardiovasc Imaging 4(3):259–268

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Supported by the European Regional Development Fund—Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. 1st Department of Internal Medicine – Cardioangiology, International Clinical Research Center, St. Anne’s University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic

    Zdeněk Stárek, František Lehar, Jiří Jež, Jiří Wolf & Miroslav Novák

Authors
  1. Zdeněk Stárek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. František Lehar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jiří Jež
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiří Wolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Miroslav Novák
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zdeněk Stárek.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stárek, Z., Lehar, F., Jež, J. et al. 3D X-ray imaging methods in support catheter ablations of cardiac arrhythmias. Int J Cardiovasc Imaging 30, 1207–1223 (2014). https://doi.org/10.1007/s10554-014-0470-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-014-0470-4

Keywords

Search

Navigation