Skip to main content
SpringerLink
Log in

The seamless integration of three-dimensional rotational angiography images into electroanatomical mapping systems to guide catheter ablation of atrial fibrillation

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

It is important to visually confirm radiofrequency ablation lesions during atrial fibrillation (AF) ablation for procedural efficiency, which requires the integration of a three-dimensional (3D) left atrial image reconstructed from computed tomography (CT) or a magnetic resonance imaging. However, an EP Navigator allows seamless integration of 3D anatomy obtained through 3D rotational angiography (3D-ATG) into an electroanatomical mapping system. We hypothesized that 3D-ATG can be used during AF ablation while significantly reducing the effective dose (ED) and without compromising image morphology compared to a 3D-CT image. Organ dose was measured at 37 points with a radiophotoluminescence glass dosimeter inserted in an anthropomorphic Rando Phantom. The ED was calculated by multiplying the organ dose by the tissue weighting factor. The dose-area product (DAP)-to-ED conversion factor was calculated by measuring the DAP during radiation exposure. The ED for the CT examination was estimated from the dose-length product with a conversion factor of 0.014. ED was calculated from DAP measurements in 114 patients undergoing AF ablation using 3D-ATG. The DAP-to-ED conversion factor for 3D-ATG was 2.4 × 10−4 mSv/mGy cm2 in our hospital. The mean DAP for all patients was 7777 ± 1488 mGy cm2 for the 3D-ATG of the left atrium. The corresponding ED for 3D-ATG was 1.9 ± 0.4 mSv. The ED for CT examinations was 13.6 ± 4.2 mSv (P < 0.001). 3D-ATG can be used during AF ablation while significantly reducing the ED and without compromising image morphology.

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

Similar content being viewed by others

References

  1. Mikaelian BJ, Malchano ZJ, Neuzil P, Weichet J, Doshi SK, Ruskin JN, Reddy VY (2005) Images in cardiovascular medicine. Integration of 3-dimensional cardiac computed tomography images with real-time electroanatomic mapping to guide catheter ablation of atrial fibrillation. Circulation 112:e35–e36

    Article  Google Scholar 

  2. Noseworthy PA, Malchano ZJ, Ahmed J, Holmvang G, Ruskin JN, Reddy VY (2005) The impact of respiration on left atrial and pulmonary venous anatomy: implications for image-guided intervention. Heart Rhythm 2:1173–1178

    Article  Google Scholar 

  3. Dong J, Calkins H, Solomon SB, Lai S, Dalal D, Lardo AC, Brem E, Preiss A, Berger RD, Halperin H, Dickfeld T (2006) Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations. Circulation 113:186–194

    Article  Google Scholar 

  4. Kistler PM, Earley MJ, Harris S, Abrams D, Ellis S, Sporton SC, Schilling RJ (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 17:341–348

    Article  Google Scholar 

  5. Li JH, Haim M, Movassaghi B, Mendel JB, Chaudhry GM, Haffajee CI, Orlov MV (2009) Segmentation and registration of three-dimensional rotational angiogram on live fluoroscopy to guide atrial fibrillation ablation: a new online imaging tool. Heart Rhythm 6:231–237

    Article  Google Scholar 

  6. Tang M, Kriatselis C, Ye G, Nedios S, Roser M, Solowjowa N, Fleck E, Gerds-Li JH (2009) Reconstructing and registering three-dimensional rotational angiogram of left atrium during ablation of atrial fibrillation. Pacing Clin Electrophysiol 32:1407–1416

    Article  Google Scholar 

  7. Kriatselis C, Nedios S, Akrivakis S, Tang M, Roser M, Gerds-Li JH, Fleck E, Orlov M (2011) Intraprocedural imaging of left atrium and pulmonary veins: a comparison study between rotational angiography and cardiac computed tomography. Pacing Clin Electrophysiol 34:315–322

    Article  Google Scholar 

  8. Knecht S, Skali H, O’Neill MD, Wright M, Matsuo S, Chaudhry GM, Haffajee CI, Nault I, Gijsbers GH, Sacher F, Laurent F, Montaudon M, Corneloup O, Hocini M, Haïssaguerre M, Orlov MV, Jaïs P (2008) Computed tomography-fluoroscopy overlay evaluation during catheter ablation of left atrial arrhythmia. Europace 10:931–938

    Article  Google Scholar 

  9. Hurwitz LM, Yoshizumi TT, Goodman PC, Frush DP, Nguyen G, Toncheva G, Lowry C (2007) Effective dose determination using an anthropomorphic phantom and metal oxide semiconductor field effect transistor technology for clinical adult body multidetector array computed tomography protocols. J Comput Assist Tomog 31:544–549

    Article  Google Scholar 

  10. [No authors listed] (2007) The 2007 Recommendations of the international commission on radiological protection ICRP publication 103. Ann ICRP 37:1–332

  11. Ejima K, Shoda M, Yagishita D, Futagawa K, Yashiro B, Sato T, Manaka T, Nakajima T, Ohmori H, Hagiwara N (2010) Image integration of three-dimensional cone-beam computed tomography angiogram into electroanatomical mapping system to guide catheter ablation of atrial fibrillation. Europace 12:45–51

    Article  Google Scholar 

  12. Nölker G, Gutleben KJ, Asbach S, Vogt J, Heintze J, Brachmann J, Horstkotte D, Sinha AM (2011) Intracardiac echocardiography for registration of rotational angiography-based left atrial reconstructions: a novel approach integrating two intraprocedural three-dimensional imaging techniques in atrial fibrillation ablation. Europace 13:492–498

    Article  Google Scholar 

  13. Tan SK, Yeong CH, Ng KH, Abdul Aziz YF, Sun Z (2016) Recent update on radiation dose assessment for the state-of-the-art coronary computed tomography angiography protocols. PLoS One 11:e0161543

    Article  Google Scholar 

  14. Vano E, Gonzalez L, Ten JL, Fernandez JM, Guibelalde E, Macaya C (2001) Skin dose and dose-area product values for interventional cardiology procedures. Br J Radiol 74:48–55

    Article  CAS  Google Scholar 

  15. Delichas MG, Psarrakos K, Molyvda-Athanassopoulou E, Giannoglou G, Hatziioannou K, Papanastassiou E (2003) Radiation doses to patients undergoing coronary angiography and percutaneous transluminal coronary angioplasty. Radiat Prot Dosim 103:149–154

    Article  CAS  Google Scholar 

  16. Stisova V (2004) Effective dose to patient during cardiac interventional procedures (prague workplaces). Radiat Prot Dosim 111:271–274

    Article  Google Scholar 

  17. Bor D, Sancak T, Olgar T, Elcim Y, Adanali A, Sanlidilek U, Akyar S (2004) Comparison of effective doses obtained from dose-area product and air kerma measurements in interventional radiology. Br J Radiol 77:315–322

    Article  CAS  Google Scholar 

  18. Anand Rishi, Gorev Maxim V, Poghosyan Hermine, Pothier Lindsay, Matkins John, Kotler Gregory, Moroz Sarah, Armstrong James, Nemtsov Sergei V, Orlov Michael V (2016) Prospective randomized comparison of rotational angiography with three-dimensional reconstruction and computed tomography merged with electro-anatomical mapping: a two center atrial fibrillation ablation study. J Interv Card Electrophysiol 46:71–79

    Article  Google Scholar 

  19. Kriatselis C, Nedios S, Akrivakis S, Tang M, Roser M, Gerds-Li JH, Fleck E, Orlov M (2011) Intraprocedural imaging of left atrium and pulmonary veins: a comparison study between rotational angiography and cardiac computed tomography. Pacing Clin Electrophysiol 34:315–322

    Article  Google Scholar 

  20. Li JH, Haim M, Movassaghi B, Mendel JB, Chaudhry GM, Haffajee CI, Orlov MV (2009) Segmentation and registration of three-dimensional rotational angiogram on live fluoroscopy to guide atrial fibrillation ablation: a new online imaging tool. Heart Rhythm 6:231–237

    Article  Google Scholar 

  21. Nahass GT (1995) Fluoroscopy and the skin: implications for radiofrequency catheter ablation. Am J Cardiol 76:174–176

    Article  CAS  Google Scholar 

  22. Perisinakis K, Damilakis J, Theocharopoulos N, Manios E, Vardas P, Gourtsoyiannis N (2001) Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures. Circulation 104:58–62

    Article  CAS  Google Scholar 

  23. JCS Joint Working Group (2010) Guideline for radiation safety in interventional cardiology (JCS 2011)—digest version. Circ J 74:2760–2785

    Article  Google Scholar 

  24. Hur Jin, Kim YJ, Lee HJ, Nam JE, Ha JW, Heo JH, Chang HJ, Kim HS, Hong YJ, Kim HY, Choe KO, Choi BW (2011) Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke. A prospective comparison study with transesophageal echocardiography. Stroke 42:2471–2477

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Satoshi Fujita, Eitaro Fujii, Yoshihiko Kagawa & Masaaki Ito

  2. Department of Radiological Technology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Katsuhiro Inoue & Tsuyoshi Yamada

Authors
  1. Satoshi Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eitaro Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshihiko Kagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katsuhiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsuyoshi Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masaaki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eitaro Fujii.

Ethics declarations

Conflict of interest

Masaaki Ito received honorarium equal to or more than 500,000 yen from Daiichi Sankyo Co., Ltd., Bayer Holding Ltd., and Takeda Pharmaceutical Co., Ltd. in 2017. The Department of Cardiology and Nephrology, Mie University Graduate School of Medicine is supported in part by unrestricted research grants of equal to or more than 1,000,000 yen from Bristol-Myers Squibb K.K., MSD K.K., Shionogi & Co., Ltd., Otsuka Pharma Inc. and Takeda Pharmaceutical Co., Ltd. in 2017. The other authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujita, S., Fujii, E., Kagawa, Y. et al. The seamless integration of three-dimensional rotational angiography images into electroanatomical mapping systems to guide catheter ablation of atrial fibrillation. Heart Vessels 33, 1373–1380 (2018). https://doi.org/10.1007/s00380-018-1180-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-018-1180-y

Keywords

Search

Navigation