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Usefulness of three-dimensional pulmonary vein-left atrium image reconstructed from non-enhanced computed tomography for atrial fibrillation ablation

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Abstract

Enhanced computed tomography (CT) is unsuitable for patients with reduced renal function and/or allergy for contrast medium (CM). CT image registration into an electroanatomic system (EAMS) is essential to perform pulmonary vein isolation (PVI) safely and smoothly in patients with atrial fibrillation (AF). To create three-dimensional pulmonary vein-left atrium (3D PV-LA) images from non-enhanced CT images to register them into EAMS for AF ablation. Using a non-enhanced ECG-gated image, 3D PV-LA images were generated by our developed techniques with an EnSite image analyzing tool for patients unfit for CM use (n = 100). Segmentation between tissues was performed as follows: tissues distal from or close to PV-LA were segmented in transverse slices to clearly show the whole LA. Tissues bordering PV-LA, including the pulmonary artery, left ventricle, and right atrium, were segmented manually with great care. Practical ablation parameters were compared with those obtained from enhanced CT (n = 100). 3D PV-LA image reconstruction from non-enhanced CT imaging required a longer time than that from enhanced CT (42 ± 6 vs 14 ± 3 min). All 100 PV-LA non-enhanced CT images were successfully reconstructed and registered into the EAM system without the need for re-segmentation. Practical ablation parameters, including procedural time and AF recurrence rate, did not differ between imaging methods. This study provides clinically useful information on a detailed methodology for 3D PV-LA image reconstruction using non-enhanced CT. Non-enhanced CT 3D PV-LA images were successfully registered into the EAM system and useful for patients unsuitable for CM use.

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Data availability

The data that support the findings of this study are available from the corresponding author, S.K., upon reasonable request.

Abbreviations

AF:

Atrial fibrillation

AT:

Atrial tachycardia

CE:

Contrast medium

CT:

Computed tomography

EAMS:

Electroanatomical mapping system

LA:

Left atrium

PA:

Pulmonary artery

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

RA:

Right atrium

RV:

Right ventricle

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Acknowledgements

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan

    Souhei Kawafuji, Masaaki Kayama, Akitaka Akiyama & Motoaki Miyahara

  2. Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan

    Hirosuke Yamaji, Shunichi Higashiya, Takashi Murakami & Shozo Kusachi

  3. Division of Radiation, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan

    Takumi Tomiya, Takuto Koumoto & Takuya Akagi

  4. Department of Medical Technology, Okayama University Graduate School of Health Sciences, Shikata 2-5-1, Kita-Ku, Okayama, 700-8558, Japan

    Shozo Kusachi

Authors
  1. Souhei Kawafuji
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  2. Hirosuke Yamaji
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  3. Masaaki Kayama
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  4. Akitaka Akiyama
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  5. Motoaki Miyahara
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  6. Takumi Tomiya
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  7. Takuto Koumoto
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  8. Takuya Akagi
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  9. Shunichi Higashiya
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  10. Takashi Murakami
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  11. Shozo Kusachi
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Contributions

Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work: SK, HY, MK, AA, MM, TT, TK, TA, and SK. Drafted the work or revised it critically for important intellectual content: SK, HY, SH, TM, and SK. All authors approved this version of the manuscript to be published.

Corresponding author

Correspondence to Hirosuke Yamaji.

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Conflict of interest

There are no conflicts of interest in connection with the present study.

Ethical approval

The examination and analytical procedures adhered to the principles of the Declaration of Helsinki, and the study was approved by the Institutional Ethics Committee for Human Research of Okayama Heart Clinic. Written informed consent for the use of data without personally identifiable information was obtained from all patients.

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Kawafuji, S., Yamaji, H., Kayama, M. et al. Usefulness of three-dimensional pulmonary vein-left atrium image reconstructed from non-enhanced computed tomography for atrial fibrillation ablation. Int J Cardiovasc Imaging 39, 2517–2526 (2023). https://doi.org/10.1007/s10554-023-02943-6

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