Skip to main content
SpringerLink
Log in

Periprocedural 3D imaging of the left atrium and esophagus: comparison of different protocols of 3D rotational angiography of the left atrium and esophagus in group of 547 consecutive patients undergoing catheter ablation of the complex atrial arrhythmias

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

Abstract

A new method in creating 3D models of the left atrium (LA) and esophagus before catheter ablation of atrial arrhythmias is 3D rotational angiography (3DRA) of the LA. The purpose of this retrospective study was to test various acquisition protocols of the 3DRA and attempt to define the parameters influencing the success of the protocols. From August 2010 to November 2014, 3DRA of the LA using the Philips Allura FD 10 X-ray system was performed in 547 consecutive patients using right atrial and left atrial protocols. Visualization of the esophagus was performed after oral administration of a contrast agent. Patients were monitored for success (creation of a useful 3D models) and evaluated for a number of parameters affecting the success of 3DRA. The success of the RA protocol was 88.89 % with and 91.91 % without esophagus imaging. The success of the LA protocol was 97.42 % with and 94.54 % without esophagus imaging. The only factor reducing the success of the RA protocol was BMI; the LA protocol was not influenced by any factor. Ventricular fibrillation induced in two patients was successfully treated with defibrillation. 3DRA of the LA is a reliable method that supports catheter ablation of complex atrial arrhythmias. The LA protocol with esophagus imaging was significantly more reliable than the RA protocol; the other protocols were comparable. The RA protocol may be negatively affected by high BMI. Simultaneous imaging of the esophagus is safe and feasible, and the LA protocol can be recommended.

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

Similar content being viewed by others

References

  1. Calkins H, Kuck KH, Cappato R et al (2012) 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 33:171–257

    Article  PubMed  Google Scholar 

  2. Jongbloed MR, Bax JJ, Lamb HJ, Dirksen MS, Zeppenfeld K, van der Wall EE, de Roos A, Schalij MJ (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 45:343–350

    Article  PubMed  Google Scholar 

  3. Malchano ZJ, Neuzil P, Cury RC, Holmvang G, Weichet J, Schmidt EJ, Ruskin JN, Reddy VY (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 17:1221–1229

    Article  PubMed  Google Scholar 

  4. Orlov MV, Hoffmeister P, Chaudhry GM, Almasry I, Gijsbers GH, Swack T, Haffajee CI (2007) Three-dimensional rotational angiography of the left atrium and esophagus—a virtual computed tomography scan in the electrophysiology lab? Heart Rhythm 4:37–43

    Article  PubMed  Google Scholar 

  5. Nölker G, Gutleben KJ, Marschang H, Ritscher G, Asbach S, Marrouche N, Brachmann J, Sinha AM (2008) Three-dimensional left atrial and esophagus reconstruction using cardiac C-arm computed tomography with image integration into fluoroscopic views for ablation of atrial fibrillation: accuracy of a novel modality in comparison with multislice computed tomo. Heart Rhythm 5:1651–1657

    Article  PubMed  Google Scholar 

  6. Thiagalingam A, Manzke R, D’Avila A, Ho I, Locke AH, Ruskin JN, Chan RC, Reddy VY (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 19:293–300

    Article  PubMed  Google Scholar 

  7. 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  PubMed  Google Scholar 

  8. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E (2010) Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 3:32–38

    Article  PubMed  Google Scholar 

  9. Carpen M, Matkins J, Syros G, Gorev MV, Alikhani Z, Wylie JV, Natan SR, Griben A, Hicks A, Armstrong J, Orlov MV (2013) First experience of 3D rotational angiography fusion with NavX electroanatomical mapping to guide catheter ablation of atrial fibrillation. Heart Rhythm 10:422–427

    Article  PubMed  Google Scholar 

  10. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac diagnostic imaging. Circulation 116:1290–1305

    Article  PubMed  Google Scholar 

  11. 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  PubMed  Google Scholar 

  12. Kriatselis C, Tang M, Nedios S, Roser M, Gerds-Li H, Fleck E (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 6:733–741

    Article  PubMed  Google Scholar 

  13. 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  PubMed  Google Scholar 

  14. Kriatselis C, Tang M, Roser M, Fleck E, Gerds-Li H (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 11:35–41

    Article  PubMed  Google Scholar 

  15. 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  PubMed  Google Scholar 

  16. Thorning C, Hamady M, Liaw JV, Juli C, Lim PB, Dhawan R, Peters NS, Davies DW, Kanagaratnam P, O’Neill MD, Wright AR (2011) CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation. Clin Imaging 35:1–9

    Article  PubMed  Google Scholar 

  17. Yang L, Xu L, Yan Z, Yu W, Fan Z, Lv B, Zhang Z (2012) Low dose 320-row CT for left atrium and pulmonary veins imaging–the feasibility study. Eur J Radiol 81:1549–1554

    Article  PubMed  Google Scholar 

  18. Lehar F, Starek Z, Jez J, Novak M, Wolf J, Stepanova R, Kruzliak P, Kulik T, Zbankova A, Jancar R, Vitovec J (2015) Comparison of clinical outcomes and safety of catheter ablation for atrial fibrillation supported by data from CT scan or three-dimensional rotational angiogram of left atrium and pulmonary veins. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 159:622–628

    PubMed  Google Scholar 

  19. Knecht S, Wright M, Akrivakis S, Nault I, Matsuo S, Chaudhry GM, Haffajee C, Sacher F, Lellouche N, Miyazaki S, Forclaz A, Jadidi AS, Hocini M, Ritter P, Clementy J, Haïssaguerre M, Orlov M, Jaïs P (2010) Prospective randomized comparison between the conventional electroanatomical system and three-dimensional rotational angiography during catheter ablation for atrial fibrillation. Heart Rhythm 7:459–465

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by a Grant of the European Regional Development Fund—Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123) and Masaryk University, Faculty of Medicine, Kamenice 5, 625 00 Brno, Czech Republic.

Author information

Authors and Affiliations

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

    Zdenek Starek, František Lehar, Jiri Jez, Jiri Wolf, Tomas Kulik & Alena Zbankova

  2. Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic

    Zdenek Starek, František Lehar, Jiri Jez, Jiri Wolf, Tomas Kulik, Alena Zbankova & Miroslav Novak

Authors
  1. Zdenek Starek
    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. Jiri Jez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiri Wolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomas Kulik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alena Zbankova
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miroslav Novak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zdenek Starek.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This retrospective study received approval from the ethics committee of our institution. Informed consent was not necessary because the current study was retrospective in nature and retrospectively processed common clinical data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Starek, Z., Lehar, F., Jez, J. et al. Periprocedural 3D imaging of the left atrium and esophagus: comparison of different protocols of 3D rotational angiography of the left atrium and esophagus in group of 547 consecutive patients undergoing catheter ablation of the complex atrial arrhythmias. Int J Cardiovasc Imaging 32, 1011–1019 (2016). https://doi.org/10.1007/s10554-016-0888-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-016-0888-y

Keywords

Search

Navigation