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Integration of Imaging: Impact on Outcome of AF Ablation

Integration of Imaging: Impact on Outcome of AF Ablation. Ahmed Abdelaal, MD CHU Nancy, France. CAIROSTIM NOV 2008. AF: from mechanisms to targets. Marshall ligament Hwang C, Circulation 2000;101:1503-5. Micro-reentrant atrial circuits Sueda T, Ann Thorac Surg 1997;63:1070-5.

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Integration of Imaging: Impact on Outcome of AF Ablation

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  1. Integration of Imaging: Impact on Outcome of AF Ablation Ahmed Abdelaal, MD CHU Nancy, France CAIROSTIM NOV 2008

  2. AF: from mechanisms to targets Marshall ligament Hwang C, Circulation 2000;101:1503-5 Micro-reentrant atrial circuits Sueda T, Ann Thorac Surg 1997;63:1070-5 Pulmonary vein foci Haïssaguerre M, N Engl J Med 1998;339:659-66 Cardiac innervation Schauerte P, Circulation 2000;102:2274-80 Coronary sinus Superior vena cava Right atrial foci ... Rotor Mandapati R, Circulation 2000;101:194-99 By courtesy- Christian de Chillou

  3. Left atrium- PV anatomy Common vestibule for both LPV LSPV - LAA junction 20% 4 PV > OR < 4 PV 77% 23%

  4. Left atrium- PV Imaging

  5. Left atrium- PV Imaging ICE: 2/6 RPV (33%) • Venography overestimates PV ostial diamaters • TEE underestimates PV ostial diamaters • ICE is correlated to CT ostial diamaters

  6. Image integration: from real to virtual anatomy

  7. 3-D Image integration: back to real anatomy

  8. 3-D Image integration: back to real anatomy

  9. 3-D Image integration: back to real anatomy (1) Best landmark registration could be achieved at posterior LA-PV junctions

  10. 3-D Image integration: back to real anatomy (2) Significant landmark shift after surface registration - Positively correlated to surface registration error - Surface registration errors were more evident for RPVs

  11. 3-D Image integration: back to real life • (1) • The effect of respiration: • Classic splaying effect of PV • Minimal at LA junction • Maximum at distal PV and MA area Ector et al, JCE 2008

  12. 3-D Image integration: back to real life (2) The effect of cardiac rhythm: Patel et al, JICE 2008

  13. 3-D Image integration: back to real life (3) The effect of cardiac rhythm: Patel et al, JICE 2008

  14. 3-D Image integration: back to real life (2) The effect of cardiac cycle: Sra el et al, JICE 2008

  15. The need for 3-D image integration

  16. The need for 3-D image integration 10+/-5mm Superimposed+/-5mm

  17. The need for 3-D image integration

  18. The need for 3-D image integration

  19. The final impact of 3-D image integration on outcome of AF ablation

  20. Conclusions 1. PV isolation is still the corner stone in the ablation of atrial fibrillation. 2. Different Cardiac imaging modalities are important for precise delineation of important LA anatomical structures crucial for safe and effective ablation. 3. The use of 3D image integration could be a useful tool taking into consideration its potential limitations during the mapping procedure.

  21. Stanislas Square - Nancy

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