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Brisinda D, Fenici P, Fenici R. Clinical magnetocardiography: the unshielded bet-past, present, and future. Front Cardiovasc Med 2023; 10:1232882. [PMID: 37636301 PMCID: PMC10448194 DOI: 10.3389/fcvm.2023.1232882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/23/2023] [Indexed: 08/29/2023] Open
Abstract
Magnetocardiography (MCG), which is nowadays 60 years old, has not yet been fully accepted as a clinical tool. Nevertheless, a large body of research and several clinical trials have demonstrated its reliability in providing additional diagnostic electrophysiological information if compared with conventional non-invasive electrocardiographic methods. Since the beginning, one major objective difficulty has been the need to clean the weak cardiac magnetic signals from the much higher environmental noise, especially that of urban and hospital environments. The obvious solution to record the magnetocardiogram in highly performant magnetically shielded rooms has provided the ideal setup for decades of research demonstrating the diagnostic potential of this technology. However, only a few clinical institutions have had the resources to install and run routinely such highly expensive and technically demanding systems. Therefore, increasing attempts have been made to develop cheaper alternatives to improve the magnetic signal-to-noise ratio allowing MCG in unshielded hospital environments. In this article, the most relevant milestones in the MCG's journey are reviewed, addressing the possible reasons beyond the currently long-lasting difficulty to reach a clinical breakthrough and leveraging the authors' personal experience since the early 1980s attempting to finally bring MCG to the patient's bedside for many years thus far. Their nearly four decades of foundational experimental and clinical research between shielded and unshielded solutions are summarized and referenced, following the original vision that MCG had to be intended as an unrivaled method for contactless assessment of the cardiac electrophysiology and as an advanced method for non-invasive electroanatomical imaging, through multimodal integration with other non-fluoroscopic imaging techniques. Whereas all the above accounts for the past, with the available innovative sensors and more affordable active shielding technologies, the present demonstrates that several novel systems have been developed and tested in multicenter clinical trials adopting both shielded and unshielded MCG built-in hospital environments. The future of MCG will mostly be dependent on the results from the ongoing progress in novel sensor technology, which is relatively soon foreseen to provide multiple alternatives for the construction of more compact, affordable, portable, and even wearable devices for unshielded MCG inside hospital environments and perhaps also for ambulatory patients.
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Affiliation(s)
- D. Brisinda
- Dipartimento Scienze dell'invecchiamento, ortopediche e reumatologiche, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- School of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
| | - P. Fenici
- School of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
| | - R. Fenici
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
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2
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Maier H, Schunkert H, Navab N. Extending bioelectric navigation for displacement and direction detection. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02927-w. [PMID: 37233892 PMCID: PMC10329621 DOI: 10.1007/s11548-023-02927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Bioelectric navigation is a navigation modality for minimally invasive endovascular procedures promising non-fluoroscopic navigation. However, the method offers only limited navigation accuracy between anatomical features and expects the tracked catheter to move only in one direction at all times. We propose to extend bioelectric navigation with additional sensing capabilities, allowing for the estimation of the distance traveled by the catheter, thereby improving accuracy between feature locations and allowing to track also under alternating forward- and backward motion. METHODS We perform experiments in finite element method (FEM) simulations and in a 3D printed phantom. A solution for estimating the traveled distance using a stationary electrode is proposed, together with an approach on how to evaluate the signals obtained with this additional electrode. We investigate the effects of surrounding tissue conductance on this approach. Finally, the approach is refined in order to mitigate the effects of parallel conductance on the navigation accuracy. RESULTS The approach allows to estimate the catheter movement direction and the distance traveled. Simulations show absolute errors below 0.89 mm for non-conducting surrounding tissue, but errors up to 60.27 mm when the tissue is electrically conductive. This effect can be mitigated by a more sophisticated modeling (errors up to 33.96 mm). In experiments in a 3D printed phantom, the mean absolute error over 6 catheter paths is 6.3 mm, with standard deviations smaller than or equal to 1.1 mm. CONCLUSIONS Extending the setup of bioelectric navigation with an additional stationary electrode allows to estimate the distance traveled by the catheter, as well as the movement direction. The effects of parallel conductive tissue could be partially mitigated in simulations, but further research is needed to investigate these effects in real biological tissue, and to bring the introduced errors down to a clinically acceptable level.
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Affiliation(s)
- Heiko Maier
- Computer Aided Medical Procedures, Technical University of Munich, Boltzmannstr. 3, 85748, Garching near Munich, Bavaria, Germany.
- Deutsches Herzzentrum München Technical University of Munich, Lazarettstraße 36, 80636, Munich, Bavaria, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, 80636, Munich, Bavaria, Germany.
| | - Heribert Schunkert
- Deutsches Herzzentrum München Technical University of Munich, Lazarettstraße 36, 80636, Munich, Bavaria, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, 80636, Munich, Bavaria, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures, Technical University of Munich, Boltzmannstr. 3, 85748, Garching near Munich, Bavaria, Germany
- Computer Aided Medical Procedures, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, 21218, USA
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich, Georg-Brauchle-Ring 60-62, 80992, Munich, Bavaria, Germany
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Kushnir A, Barbhaiya CR, Aizer A, Jankelson L, Holmes D, Knotts R, Park D, Spinelli M, Bernstein S, Chinitz LA. Temporal trends in atrial fibrillation ablation procedures at an academic medical center: 2011-2021. J Cardiovasc Electrophysiol 2023; 34:800-807. [PMID: 36738147 DOI: 10.1111/jce.15839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/03/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Radiofrequency ablation technology for treating atrial fibrillation (AF) has evolved rapidly over the past decade. We investigated the impact of technological and procedural advances on procedure times and ablation outcomes at a major academic medical center over a 10-year period. METHODS Clinical data was collected from patients who presented to NYU Langone Health between 2011 and 2021 for a first-time AF ablation. Time to redo AF ablation or direct current cardioversion (DCCV) for recurrent AF during a 3-year follow-up period was determined and correlated with ablation technology and practices, antiarrhythmic medications, and patient comorbid conditions. RESULTS From 2011 to 2021, the cardiac electrophysiology lab adopted irrigated-contact force ablation catheters, high-power short duration ablation lesions, steady-pacing, jet ventilation, and eliminated stepwise linear ablation for AF ablation. During this time the number of first time AF ablations increased from 403 to 1074, the percentage of patients requiring repeat AF-related intervention within 3-years of the index procedure dropped from 22% to 14%, mean procedure time decreased from 271 ± 65 to 135 ± 36 min, and mean annual major adverse event rate remained constant at 1.1 ± 0.5%. Patient comorbid conditions increased during this time period and antiarrhythmic use was unchanged. CONCLUSION Rates of redo-AF ablation or DCCV following an initial AF ablation at a single center decreased 36% over a 10-year period. Procedural and technological changes likely contributed to this improvement, despite increased AF related comorbidities.
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Affiliation(s)
- Alexander Kushnir
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - David Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
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Stoks J, Hermans BJM, Boukens BJD, Holtackers RJ, Gommers S, Kaya YS, Vernooy K, Cluitmans MJM, Volders PGA, Ter Bekke RMA. High-resolution structural-functional substrate-trigger characterization: Future roadmap for catheter ablation of ventricular tachycardia. Front Cardiovasc Med 2023; 10:1112980. [PMID: 36873402 PMCID: PMC9978225 DOI: 10.3389/fcvm.2023.1112980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Patients with ventricular tachyarrhythmias (VT) are at high risk of sudden cardiac death. When appropriate, catheter ablation is modestly effective, with relatively high VT recurrence and complication rates. Personalized models that incorporate imaging and computational approaches have advanced VT management. However, 3D patient-specific functional electrical information is typically not considered. We hypothesize that incorporating non-invasive 3D electrical and structural characterization in a patient-specific model improves VT-substrate recognition and ablation targeting. Materials and methods In a 53-year-old male with ischemic cardiomyopathy and recurrent monomorphic VT, we built a structural-functional model based on high-resolution 3D late-gadolinium enhancement (LGE) cardiac magnetic resonance imaging (3D-LGE CMR), multi-detector computed tomography (CT), and electrocardiographic imaging (ECGI). Invasive data from high-density contact and pace mapping obtained during endocardial VT-substrate modification were also incorporated. The integrated 3D electro-anatomic model was analyzed off-line. Results Merging the invasive voltage maps and 3D-LGE CMR endocardial geometry led to a mean Euclidean node-to-node distance of 5 ± 2 mm. Inferolateral and apical areas of low bipolar voltage (<1.5 mV) were associated with high 3D-LGE CMR signal intensity (>0.4) and with higher transmurality of fibrosis. Areas of functional conduction delay or block (evoked delayed potentials, EDPs) were in close proximity to 3D-LGE CMR-derived heterogeneous tissue corridors. ECGI pinpointed the epicardial VT exit at ∼10 mm from the endocardial site of origin, both juxtaposed to the distal ends of two heterogeneous tissue corridors in the inferobasal left ventricle. Radiofrequency ablation at the entrances of these corridors, eliminating all EDPs, and at the VT site of origin rendered the patient non-inducible and arrhythmia-free until the present day (20 months follow-up). Off-line analysis in our model uncovered dynamic electrical instability of the LV inferolateral heterogeneous scar region which set the stage for an evolving VT circuit. Discussion and conclusion We developed a personalized 3D model that integrates high-resolution structural and electrical information and allows the investigation of their dynamic interaction during arrhythmia formation. This model enhances our mechanistic understanding of scar-related VT and provides an advanced, non-invasive roadmap for catheter ablation.
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Affiliation(s)
- Job Stoks
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, Netherlands.,Department of Advanced Computing Sciences, Maastricht University, Maastricht, Netherlands.,Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Ben J M Hermans
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Bas J D Boukens
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands.,Department of Medical Biology, Amsterdam University Medical Center (UMC), Amsterdam Medical Center (AMC), Amsterdam, Netherlands
| | - Robert J Holtackers
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, Netherlands
| | - Suzanne Gommers
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, Netherlands
| | - Yesim S Kaya
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, Netherlands
| | - Matthijs J M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, Netherlands.,Philips Research, Eindhoven, Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, Netherlands
| | - Rachel M A Ter Bekke
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, Netherlands
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Douglas JE, Patel TD, Rullan-Oliver BE, Kohanski MA, Palmer JN, Adappa ND. Novel intraoperative fast anatomic mapping as teaching adjunct in endoscopic sinus surgery. Int Forum Allergy Rhinol 2022; 12:1575-1577. [PMID: 35687529 DOI: 10.1002/alr.23046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jennifer E Douglas
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA.,Monell Chemical Senses Center, Philadelphia, PA
| | - Tapan D Patel
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Bianca E Rullan-Oliver
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA
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Schmidt EJ, Olson G, Tokuda J, Alipour A, Watkins RD, Meyer EM, Elahi H, Stevenson WG, Schweitzer J, Dumoulin CL, Johnson T, Kolandaivelu A, Loew W, Halperin HR. Intracardiac MR imaging (ICMRI) guiding-sheath with amplified expandable-tip imaging and MR-tracking for navigation and arrythmia ablation monitoring: Swine testing at 1.5 and 3T. Magn Reson Med 2022; 87:2885-2900. [PMID: 35142398 PMCID: PMC8957513 DOI: 10.1002/mrm.29168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/30/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Develop a deflectable intracardiac MR imaging (ICMRI) guiding-sheath to accelerate imaging during MR-guided electrophysiological (EP) interventions for radiofrequency (500 kHz) ablation (RFA) of arrythmia. Requirements include imaging at three to five times surface-coil SNR in cardiac chambers, vascular insertion, steerable-active-navigation into cardiac chambers, operation with ablation catheters, and safe levels of MR-induced heating. METHODS ICMRI's 6 mm outer-diameter (OD) metallic-braided shaft had a 2.6 mm OD internal lumen for ablation-catheter insertion. Miniature-Baluns (MBaluns) on ICMRI's 1 m shaft reduced body-coil-induced heating. Distal section was a folded "star"-shaped imaging-coil mounted on an expandable frame, with an integrated miniature low-noise-amplifier overcoming cable losses. A handle-activated movable-shaft expanded imaging-coil to 35 mm OD for imaging within cardiac-chambers. Four MR-tracking micro-coils enabled navigation and motion-compensation, assuming a tetrahedron-shape when expanded. A second handle-lever enabled distal-tip deflection. ICMRI with a protruding deflectable EP catheter were used for MR-tracked navigation and RFA using a dedicated 3D-slicer user-interface. ICMRI was tested at 3T and 1.5T in swine to evaluate (a) heating, (b) cardiac-chamber access, (c) imaging field-of-view and SNR, and (d) intraprocedural RFA lesion monitoring. RESULTS The 3T and 1.5T imaging SNR demonstrated >400% SNR boost over a 4 × 4 × 4 cm3 FOV in the heart, relative to body and spine arrays. ICMRI with MBaluns met ASTM/IEC heating limits during navigation. Tip-deflection allowed navigating ICMRI and EP catheter into atria and ventricles. Acute-lesion long-inversion-time-T1-weighted 3D-imaging (TWILITE) ablation-monitoring using ICMRI required 5:30 min, half the time needed with surface arrays alone. CONCLUSION ICMRI assisted EP-catheter navigation to difficult targets and accelerated RFA monitoring.
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Affiliation(s)
- Ehud J. Schmidt
- Medicine (Cardiology)Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Gregory Olson
- Cardiac Arrhythmia and Heart Failure DivisionAbbott LaboratoriesMinnetonkaMinnesotaUSA
| | - Junichi Tokuda
- RadiologyBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Akbar Alipour
- Medicine (Cardiology)Johns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Eric M. Meyer
- Medicine (Cardiology)Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Hassan Elahi
- Medicine (Cardiology)Johns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Jeffrey Schweitzer
- Cardiac Arrhythmia and Heart Failure DivisionAbbott LaboratoriesMinnetonkaMinnesotaUSA
| | | | | | | | - Wolfgang Loew
- RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiOhioUSA
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7
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Abeln BGS, van den Broek JLPM, van Dijk VF, Balt JC, Wijffels MCEF, Dekker LRC, Boersma LVA. Dielectric imaging for electrophysiology procedures: The technology, current state, and future potential. J Cardiovasc Electrophysiol 2021; 32:1140-1146. [PMID: 33629788 DOI: 10.1111/jce.14971] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Abstract
Electroanatomic mapping systems have become an essential tool to guide the identification and ablation of arrhythmic substrate. Recently, a novel guiding system for electrophysiology procedures was introduced that uses dielectric sensing to perform high resolution anatomical imaging. Dielectric imaging systems use electrical fields to differentiate anatomic structures based on their conductivity and permittivity. This technique enables non-fluoroscopic, noncontact mapping of anatomic structures, assessment of pulmonary vein occlusion state during cryoballoon ablation, and has the potential to assess for additional tissue characterization including tissue thickness and tissue type. This article elaborates on the functioning and potential of dielectric imaging systems and provides two cases to illustrate the clinical impact for electrophysiology procedures.
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Affiliation(s)
- Bob G S Abeln
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Vincent F van Dijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jippe C Balt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Lukas R C Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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8
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Southworth MK, Silva JNA, Blume WM, Van Hare GF, Dalal AS, Silva JR. Performance Evaluation of Mixed Reality Display for Guidance During Transcatheter Cardiac Mapping and Ablation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2020; 8:1900810. [PMID: 32742821 PMCID: PMC7390021 DOI: 10.1109/jtehm.2020.3007031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/18/2023]
Abstract
Cardiac electrophysiology procedures present the physician with a wealth of 3D information, typically presented on fixed 2D monitors. New developments in wearable mixed reality displays offer the potential to simplify and enhance 3D visualization while providing hands-free, dynamic control of devices within the procedure room. OBJECTIVE This work aims to evaluate the performance and quality of a mixed reality system designed for intraprocedural use in cardiac electrophysiology. METHOD The Enhanced Electrophysiology Visualization and Interaction System (ĒLVIS) mixed reality system performance criteria, including image quality, hardware performance, and usability were evaluated using existing display validation procedures adapted to the electrophysiology specific use case. Additional performance and user validation were performed through a 10 patient, in-human observational study, the Engineering ĒLVIS (E2) Study. RESULTS The ĒLVIS system achieved acceptable frame rate, latency, and battery runtime with acceptable dynamic range and depth distortion as well as minimal geometric distortion. Bench testing results corresponded with physician feedback in the observational study, and potential improvements in geometric understanding were noted. CONCLUSION The ĒLVIS system, based on current commercially available mixed reality hardware, is capable of meeting the hardware performance, image quality, and usability requirements of the electroanatomic mapping display for intraprocedural, real-time use in electrophysiology procedures. Verifying off the shelf mixed reality hardware for specific clinical use can accelerate the adoption of this transformative technology and provide novel visualization, understanding, and control of clinically relevant data in real-time.
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Affiliation(s)
| | - Jennifer N. Avari Silva
- SentiAR, Inc.St. LouisMO63108USA
- Department of PediatricsSchool of MedicineWashington University in St. LouisSt. LouisMO63130USA
| | | | - George F. Van Hare
- Department of PediatricsSchool of MedicineWashington University in St. LouisSt. LouisMO63130USA
| | - Aarti S. Dalal
- Department of PediatricsSchool of MedicineWashington University in St. LouisSt. LouisMO63130USA
| | - Jonathan R. Silva
- SentiAR, Inc.St. LouisMO63108USA
- Department of Biomedical EngineeringWashington University in St. LouisSt. LouisMO63130USA
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Lai D, Ding F, Xie C, Zhang Y. An Adaptive Respiratory Motion Compensation Algorithm with Singular Value Decomposition for Intracardiac Catheter Tracking . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5065-5068. [PMID: 33019125 DOI: 10.1109/embc44109.2020.9176152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During radiofrequency catheterization for atrial fibrillation, how to accurately obtain non-X-ray intracardiac catheter position is crucial to successful endocardial mapping and ablation treatment. The major limitation of the cost-effective intracardiac catheter tracking with transthoracic electrical-fields is that the distribution of electrical conductivity within the volume torso remains dynamics and nonlinear and changes with the patient's respiratory motion. Studies have shown respiratory motion-induced catheter localization error over 20 mm. In this study, we present a novel adaptive respiratory motion compensation algorithm with singular value decomposition for reducing the interference of respiration to ensure the accuracy of intracardiac catheter localization. Animal experiments in swine were carried out for assessing the performance of the propose method through a comparison with a traditional filtering method. The obtained results demonstrate that the proposed adaptive filter based on the SVD performed well to track the original information of catheter position by accurately and timely removing the respiratory interference in case of either a fast- or slow- moving catheter operation. Future applications of this algorithm would be potentially useful for intracardiac catheter localization and real-time tracking.
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10
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Schmale IL, Vandelaar LJ, Luong AU, Citardi MJ, Yao WC. Image-Guided Surgery and Intraoperative Imaging in Rhinology: Clinical Update and Current State of the Art. EAR, NOSE & THROAT JOURNAL 2020; 100:NP475-NP486. [PMID: 32453646 DOI: 10.1177/0145561320928202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Image-guided surgery (IGS) has gained widespread acceptance in otorhinolaryngology for its applications in sinus and skull base surgery. Although the core concepts of IGS have not changed, advances in image guidance technology, including the incorporation of intraoperative imaging, have the potential to enhance surgical education, allow for more rigorous preoperative planning, and aid in more complete surgery with improved outcomes. OBJECTIVES Provide a clinical update regarding the use of image guidance and intraoperative imaging in the field of rhinology and endoscopic skull base surgery with a focus on current state of the art technologies. METHODS English-language studies published in PubMed, Cochrane, and Embase were searched for articles relating to image-guided sinus surgery, skull base surgery, and intraoperative imaging. Relevant studies were reviewed and critical appraisals were included in this clinical update, highlighting current state of the art advances. CONCLUSIONS As image guidance and intraoperative imaging systems have advanced, their applications in sinus and skull base surgery have expanded. Both technologies offer invaluable real-time feedback on the status and progress of surgery, and thus may help to improve the completeness of surgery and overall outcomes. Recent advances such as augmented and virtual reality offer a window into the future of IGS. Future advancements should aim to enhance the surgeon's operative experience by improving user satisfaction and ultimately lead to better surgical results.
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Affiliation(s)
- Isaac L Schmale
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Laura J Vandelaar
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
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11
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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12
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Romanov A, Dichterman E, Schwartz Y, Ibragimov Z, Ben-David Y, Rodriguez H, Pokushalov E, Siddiqui UR, Kadlec A, Ben-Haim SA. High-resolution, real-time, and nonfluoroscopic 3-dimensional cardiac imaging and catheter navigation in humans using a novel dielectric-based system. Heart Rhythm 2019; 16:1883-1889. [DOI: 10.1016/j.hrthm.2019.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 12/19/2022]
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13
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Rogers AJ, Narayan SM. Dielectric-based imaging and navigation of the heart. Heart Rhythm 2019; 16:1890-1891. [PMID: 31323349 DOI: 10.1016/j.hrthm.2019.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Albert J Rogers
- Cardiovascular Division, Stanford University, Stanford, California
| | - Sanjiv M Narayan
- Cardiovascular Division, Stanford University, Stanford, California.
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14
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Pires LM, Leiria TLL, Kruse ML, de Lima GG. Non-fluoroscopic catheter ablation: A randomized trial. Indian Pacing Electrophysiol J 2019; 19:189-194. [PMID: 31238125 PMCID: PMC6823701 DOI: 10.1016/j.ipej.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/05/2019] [Accepted: 06/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background Catheter ablation provides curative treatment for tachyarrhythmias. Fluoroscopy, the method used for this, presents several risks. The electroanatomical mapping (MEA) presents a three-dimensional image without using X-rays, and may be adjunct to fluoroscopy. Objectives We evaluated the possibility of performing catheter ablation with the exclusive use of electroanatomical mapping (MEA), dispensing with fluoroscopy. We compared the total time of procedure and success rates against the technique using fluoroscopy (RX) with emission of X-rays. Methods Randomized, unicentric, uni-blind study of patients referred for tachyarrhythmia ablation. Results Twelve patients were randomized to the XR group and 11 to the EAM group. The mean age was 48.5 (±12.6) vs 46.3 (±16.6) (P = ns). Success occurred in 11 patients (91.7%) in the RX group and 9 (81.8%) in the MEA group (P = 0.46). The procedure time in minutes was higher in the MEA group than in the RX group (79-47-125min vs 49-30-100min; P = 0.006). The mean fluoroscopy time was 11 ± 9 min versus zero (RX vs MEA: P < 0.001). The mean radiofrequency applications were lower in the RX group against the MEA group (6 ± 3.5 × 13.2 ± 18.2 p < 0.019). There were no complications. Conclusion MEA opened new therapeutic possibilities for patients with arrhythmias, reducing the risk of radiation. In this study, it was possible to demonstrate that it is feasible to perform ablation only with the use of MEA, with similar success with fluoroscopy, at the expense of a longer procedure time.
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Affiliation(s)
- Leonardo Martins Pires
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil.
| | - Tiago Luiz Luz Leiria
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil.
| | - Marcelo Lapa Kruse
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil
| | - Gustavo Glotz de Lima
- Cardiology Institute of Rio Grande Do Sul, University Foundation of Cardiology, Porto Alegre, RS, Brazil; Department of Clinical Medicine, UFCSPA, Brazil
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15
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Hua W, Hu YR, Gu M, Cai C, Chen XH, Niu HX, Zhang S. A feasible approach for His bundle pacing using a novel mapping system in patients receiving pacemaker therapy. HeartRhythm Case Rep 2019; 5:433-435. [PMID: 31453097 PMCID: PMC6702235 DOI: 10.1016/j.hrcr.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wei Hua
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Ran Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chi Cai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu-Hua Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Xia Niu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Patel H, Hiner E, Naqvi A, Wrobel J, Machado C. The safety and efficacy of electroanatomical mapping (EAM)-guided device implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:897-903. [PMID: 31106434 DOI: 10.1111/pace.13724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/19/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The conventional method of device implantation requires fluoroscopic guidance. With the guidance of three-dimensional (3-D) navigation systems, devices can be implanted with minimal use of fluoroscopy. To date, this technique has been reported in several case reports in young, pregnant patients. However, this technique has not been widely utilized by electrophysiologists, despite offering several benefits, including reduced radiation exposure for the patient and the operator. METHODS In this study, we evaluated 18 patients who successfully underwent device implantation with limited use of fluoroscopy under the guidance of the EnSite Precision 3-D mapping navigation system (Abbott, St. Paul, MN, USA). In most of the patients, the total fluoroscopy time was 1 s, accounted by a single postprocedural frame to insure appropriate lead placement. RESULTS A total of 19 leads were implanted in 18 patients (14 male, four female) using the electroanatomical mapping (EAM)-guided technique. A total of 19 leads were implanted in 15 patients (10 male, five female) using the conventional method. The average length of stay was 1.20 days in the EAM group compared to 1.47 days in the conventional group (P = .10). Majority of the devices implanted in both groups were single-chamber implantable cardiac defibrillators (VVI ICD, Abbott) implanted for cardiomyopathy with left ventricular ejection fraction persistently below 35%, including 88% (16/18) in the EAM group compared to 73% (11/15) in the conventional group. No periprocedural or immediate postprocedure complications were reported in either group. Device parameters, including impedance, capture time, and capture voltage, showed no significant difference in either group. Total radiation time and radiation dose were markedly lower in the EAM-guided implantation group. CONCLUSIONS In patients who meet appropriate criteria for device implantation, the use of EAM system offers a safe, practical, efficacious alternative method to device implantation, with significant reduction in radiation time and dose.
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Affiliation(s)
- Hardik Patel
- Department of Cardiology, Ascension Providence Hospital, Michigan State University, Southfield, Michigan
| | - Evan Hiner
- Department of Cardiology, Ascension Providence Hospital, Michigan State University, Southfield, Michigan
| | - Amir Naqvi
- Department of Cardiology, Ascension Providence Hospital, Michigan State University, Southfield, Michigan
| | | | - Christian Machado
- Department of Cardiology, Ascension Providence Hospital, Michigan State University, Southfield, Michigan
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17
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Schneider HE, Stahl M, Schillinger W, Müller M, Backhoff D, Schill M, Groene N, Krause U, Sigler M, Paul T. Double cryoenergy application (freeze-thaw-freeze) at growing myocardium: Lesion volume and effects on coronary arteries late after energy application. Implications for efficacy and safety in pediatric patients. J Cardiovasc Electrophysiol 2019; 30:1127-1134. [PMID: 31111603 DOI: 10.1111/jce.13993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cryoenergy is accepted as an alternative to radiofrequency ablation (RFA) in childen for ablation of supraventricular tachycardia substrates. Single cryoenergy application has been shown to be inferior to RFA. Double cryoenergy application has therefore been introduced into clinical practice, but experience concerning efficacy is limited. Coronary artery stenosis has been reported as serious complication after RFA for arrhythmia substrates but not after single cryoablation. The purpose of the study was to assess lesion volume (efficacy) and risk of coronary artery damage (safety), late, that is, 6 months, after double cryoenergy application in a piglet model. METHODS Two sequential cycles of cryoenergy were delivered at -75°C for 4 minutes at the atrioventricular groove in five piglets. Animals were restudied after 6 months by coronary angiography and intracoronary ultrasound (ICUS). Ablation lesions were examined histologically and lesion volume was determined by three-dimensional morphometric analysis. RESULTS Cryolesion volume was 174.04 ± 67.18 mm3 for atrial and 238.69 ± 112.1 mm3 for ventricular lesions (P > .05). Ventricular lesions, 4.06 ± 1.05 mm, were significantly deeper than atrial lesions, 3.58 ± 0.78 mm, (P < .05). In two of the 29 lesions, cryoenergy induced minor coronary artery injury with mild medial and adventitial thickening as well as minimal intimal proliferation, which had neither been detected by coronary angiography nor by ICUS. CONCLUSION Late after double cryoenergy application at growing myocardium, subclinical minor affection of the coronary artery wall could be detected with minimal intimal proliferation. As lifetime sequelae of this finding remains unknown, further studies are warranted to address safety of repeated cycles of cryoenergy application for tachycardia substrates in children.
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Affiliation(s)
- Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Maja Stahl
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Wolfgang Schillinger
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | | | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Manfred Schill
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Nehle Groene
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
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18
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Sieniewicz BJ, Behar JM, Sohal M, Gould J, Claridge S, Porter B, Niederer S, Gamble JHP, Betts TR, Jais P, Derval N, Spragg DD, Steendijk P, van Gelder BM, Bracke FA, Rinaldi CA. Electrical latency predicts the optimal left ventricular endocardial pacing site: results from a multicentre international registry. Europace 2018; 20:1989-1996. [PMID: 29688340 DOI: 10.1093/europace/euy052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Abstract
Aims The optimal site for biventricular endocardial (BIVENDO) pacing remains undefined. Acute haemodynamic response (AHR) is reproducible marker of left ventricular (LV) contractility, best expressed as the change in the maximum rate of LV pressure (LV-dp/dtmax), from a baseline state. We examined the relationship between factors known to impact LV contractility, whilst delivering BIVENDO pacing at a variety of LV endocardial (LVENDO) locations. Methods and results We compiled a registry of acute LVENDO pacing studies from five international centres: Johns Hopkins-USA, Bordeaux-France, Eindhoven-The Netherlands, Oxford-United Kingdom, and Guys and St Thomas' NHS Foundation Trust, London-UK. In all, 104 patients incorporating 687 endocardial and 93 epicardial pacing locations were studied. Mean age was 66 ± 11 years, mean left ventricular ejection fraction 24.6 ± 7.7% and mean QRS duration of 163 ± 30 ms. In all, 50% were ischaemic [ischaemic cardiomyopathy (ICM)]. Scarred segments were associated with worse haemodynamics (dp/dtmax; 890 mmHg/s vs. 982 mmHg/s, P < 0.01). Delivering BiVENDO pacing in areas of electrical latency was associated with greater improvements in AHR (P < 0.01). Stimulating late activating tissue (LVLED >50%) achieved greater increases in AHR than non-late activating tissue (LVLED < 50%) (8.6 ± 9.6% vs. 16.1 ± 16.2%, P = 0.002). However, the LVENDO pacing location with the latest Q-LV, was associated with the optimal AHR in just 62% of cases. Conclusions Identifying viable LVENDO tissue which displays late electrical activation is crucial to identifying the optimal BiVENDO pacing site. Stimulating late activating tissue (LVLED >50%) yields greater improvements in AHR however, the optimal location is frequently not the site of latest activation.
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Affiliation(s)
- Benjamin J Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, London, UK.,Department of Cardiology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan M Behar
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, London, UK.,Department of Cardiology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Manav Sohal
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, London, UK.,Department of Cardiology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, London, UK.,Department of Cardiology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, London, UK.,Department of Cardiology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, London, UK.,Department of Cardiology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, London, UK
| | | | - Tim R Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | | | | | | | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, London, UK.,Department of Cardiology, Guys and St Thomas' NHS Foundation Trust, London, UK
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19
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Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter? Cardiol J 2018; 26:451-458. [PMID: 30246235 DOI: 10.5603/cj.a2018.0114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 07/16/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). It is currently unclear if routine screening for PVS by imaging (echocardiography, computed tomography) is clinically meaningful and if there is a correlation between PVS and the electroanatomical mapping system (EAMS) used for the ablation procedure. It was therefore investigated in the current single center experience. METHODS All patients from January 2004 to December 2016 with the diagnosis of PVS after interventional ablation of AF by radiofrequency were retrospectively analyzed. From 2004 to 2007, transesophageal echocardiography was routinely performed as screening for RFA-acquired PVS (group A). Since 2008, diagnostics were only initiated in cases of clinical symptoms suggestive for PVS (group B). RESULTS The overall PVS rate after interventional RFA for AF of the documented institution is 0.72% (70/9754). The incidence was not influenced by screening: group A had a 0.74% PVS rate and group B a 0.72% rate (NS). Referred to as the EAMS, there were significant differences: 20/4229 (0.5%) using CARTO®, 48/4510 (1.1%) using EnSite®, 1/853 (0.1%) using MediGuide®, and 1/162 (0.6%) using Rhythmia®. Since 2009, no significant difference between technologies was found. CONCLUSIONS The present analysis of 9754 procedures revealed 70 cases of PVS. The incidence of PVS is not related to screening but to the application of different EAMS. Possible explanations are technological backgrounds (magnetic vs. electrical), learning curves, operator experience, and work-flow differences. Furthermore, incorporation of new technologies seems to be associated with higher incidences of PVS before workflows are optimized.
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20
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Guo P, Qiu J, Wang Y, Chen G, Proietti R, Fadhle ALS, Zhao C, Wen Wang D. Zero-fluoroscopy permanent pacemaker implantation using Ensite NavX system: Clinical viability or fanciful technique? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:122-127. [PMID: 29222861 DOI: 10.1111/pace.13248] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/19/2017] [Accepted: 11/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ping Guo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
- Division of Cardiology, Department of Internal Medicine; The Second Affiliated Hospital of Zhengzhou University; Zhengzhou P. R. China
| | - Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Riccardo Proietti
- Division of Cardiology, Morriston Hospital; Swansea University; Swansea UK
- Division of Cardiology, Luigi Sacco Hospital; University of Milan; Milan Italy
| | - AL-Selmi Fadhle
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan P. R. China
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21
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Guhl EN, Adelstein E, Voigt A, Wang NC, Saba S, Jain SK. Impact of 3D mapping on procedural characteristics and outcomes in cryoballoon pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol 2018; 51:71-75. [DOI: 10.1007/s10840-017-0304-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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22
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Padmanabhan D, Foxall T, Drakulic B, Witt C, Killu A, Naksuk N, Sugrue A, Venkatachalam KL, Asirvatham S. Initial Experience with the BioSig PURE EP™ Signal Recording System: An Animal Laboratory Experience. J Innov Card Rhythm Manag 2017; 8:2690-2699. [PMID: 32494447 PMCID: PMC7252935 DOI: 10.19102/icrm.2017.080407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/11/2017] [Indexed: 11/06/2022] Open
Abstract
Current signal recording and processing systems have come a long way since their initial inception and use. There is, however, still ample scope for improvement, not only in the troubleshooting of their limitations, but also in the expansion of the boundaries in the recording of intracardiac signals. Here, we recount our experience with the use of the PURE EP™ signal recording system (BioSig Technologies, Inc., Minneapolis, MN, USA) in the animal laboratory.
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Affiliation(s)
| | | | | | - Chance Witt
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ammar Killu
- Department of Electrophysiology, Brigham and Womens' Hospital, Boston, MA
| | - Niyada Naksuk
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Alan Sugrue
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - K L Venkatachalam
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL
| | - Samuel Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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23
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Behar JM, Jackson T, Hyde E, Claridge S, Gill J, Bostock J, Sohal M, Porter B, O'Neill M, Razavi R, Niederer S, Rinaldi CA. Optimized Left Ventricular Endocardial Stimulation Is Superior to Optimized Epicardial Stimulation in Ischemic Patients With Poor Response to Cardiac Resynchronization Therapy: A Combined Magnetic Resonance Imaging, Electroanatomic Contact Mapping, and Hemodynamic Study to Target Endocardial Lead Placement. JACC Clin Electrophysiol 2016; 2:799-809. [PMID: 28066827 PMCID: PMC5196018 DOI: 10.1016/j.jacep.2016.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the optimal pacing site for the left ventricular (LV) lead in ischemic patients with poor response to cardiac resynchronization therapy (CRT). BACKGROUND LV endocardial pacing may offer benefit over conventional CRT in ischemic patients. METHODS We performed cardiac magnetic resonance, invasive electroanatomic mapping (EAM), and measured the acute hemodynamic response (AHR) in patients with existing CRT systems. RESULTS In all, 135 epicardial and endocardial pacing sites were tested in 8 patients. Endocardial pacing was superior to epicardial pacing with respect to mean AHR (% change in dP/dtmax vs. baseline) (11.81 [-7.2 to 44.6] vs. 6.55 [-11.0 to 19.7]; p = 0.025). This was associated with a similar first ventricular depolarization (Q-LV) (75 ms [13 to 161 ms] vs. 75 ms [25 to 129 ms]; p = 0.354), shorter stimulation-QRS duration (15 ms [7 to 43 ms] vs. 19 ms [5 to 66 ms]; p = 0.010) and shorter paced QRS duration (149 ms [95 to 218 ms] vs. 171 ms [120 to 235 ms]; p < 0.001). The mean best achievable AHR was higher with endocardial pacing (25.64 ± 14.74% vs. 12.64 ± 6.76%; p = 0.044). Furthermore, AHR was significantly greater pacing the same site endocardially versus epicardially (15.2 ± 10.7% vs. 7.6 ± 6.3%; p = 0.014) with a shorter paced QRS duration (137 ± 22 ms vs. 166 ± 30 ms; p < 0.001) despite a similar Q-LV (70 ± 38 ms vs. 79 ± 34 ms; p = 0.512). Lack of capture due to areas of scar (corroborated by EAM and cardiac magnetic resonance) was associated with a poor AHR. CONCLUSIONS In ischemic patients with poor CRT response, biventricular endocardial pacing is superior to epicardial pacing. This may reflect accessibility to sites that cannot be reached via coronary sinus anatomy and/or by access to more rapidly conducting tissue. Furthermore, guidance to the optimal LV pacing site may be aided by modalities such as cardiac magnetic resonance to target delayed activating sites while avoiding scar.
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Key Words
- AHR, acute hemodynamic response
- CMR, cardiac magnetic resonance
- CRT
- CRT, cardiac resynchronization therapy
- EAM, electroanatomic mapping
- LV, left ventricle/ventricular
- LVendo, left ventricular endocardium
- LVepi, optimal epicardial response
- LVepi1, implanted LV lead
- LVepi2, temporary LV lead
- Q-LV, first ventricular depolarization
- cardiac magnetic resonance imaging
- electroanatomic map
- endocardial pacing
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Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Eoin Hyde
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Simon Claridge
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Jaswinder Gill
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Julian Bostock
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Manav Sohal
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Bradley Porter
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Mark O'Neill
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Steve Niederer
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Christopher Aldo Rinaldi
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
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Real-time correction of respiratory-induced cardiac motion during electroanatomical mapping procedures. Med Biol Eng Comput 2016; 54:1741-1749. [PMID: 27016363 PMCID: PMC5069333 DOI: 10.1007/s11517-016-1455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 01/29/2016] [Indexed: 11/18/2022]
Abstract
Treatment planning during catheter interventions in the heart is often based on electromechanical tissue characteristics obtained by endocardial surface mapping (ESM). Since studies have shown respiratory-induced cardiac motion of over 5 mm in different directions, respiratory motion may cause ESMs artifacts due to faulty interpolation. Hence, we designed and tested a real-time respiration-correction algorithm for ESM. An experimental phantom was used to design the correction algorithm which was subsequently evaluated in five pigs. A piezo-respiratory belt transducer was used to measure the respiration. The respiratory signal was inserted to the NOGA®XP electromechanical mapping system via the ECG leads. The results of the correction were assessed by measuring the displacement of a reference point and the registration error of the ESM on a CMR scan before and after correction. In the phantom experiment, the reference point displacement was 6.5 mm before and 1.1 mm after correction and the registration errors were 2.8 ± 2.2 and 1.9 ± 1.3 mm, respectively. In the animals, the average reference point displacement (apex) was reduced from 2.6 ± 1.0 mm before to 1.2 ± 0.3 mm after correction (P < 0.05). The in vivo registration error of the ESM and the CMR scan did not significantly improve. Even though the apical movement appreciated in pigs is small, the correction algorithm shows a decrease in displacement after correction. Application of this algorithm omits the use of the time-consuming respiratory gating during ESM and may lead to less respiratory artifacts in clinical endocardial mapping procedures.
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ECG imaging of ventricular tachycardia: evaluation against simultaneous non-contact mapping and CMR-derived grey zone. Med Biol Eng Comput 2016; 55:979-990. [PMID: 27651061 DOI: 10.1007/s11517-016-1566-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Abstract
ECG imaging is an emerging technology for the reconstruction of cardiac electric activity from non-invasively measured body surface potential maps. In this case report, we present the first evaluation of transmurally imaged activation times against endocardially reconstructed isochrones for a case of sustained monomorphic ventricular tachycardia (VT). Computer models of the thorax and whole heart were produced from MR images. A recently published approach was applied to facilitate electrode localization in the catheter laboratory, which allows for the acquisition of body surface potential maps while performing non-contact mapping for the reconstruction of local activation times. ECG imaging was then realized using Tikhonov regularization with spatio-temporal smoothing as proposed by Huiskamp and Greensite and further with the spline-based approach by Erem et al. Activation times were computed from transmurally reconstructed transmembrane voltages. The results showed good qualitative agreement between the non-invasively and invasively reconstructed activation times. Also, low amplitudes in the imaged transmembrane voltages were found to correlate with volumes of scar and grey zone in delayed gadolinium enhancement cardiac MR. The study underlines the ability of ECG imaging to produce activation times of ventricular electric activity-and to represent effects of scar tissue in the imaged transmembrane voltages.
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Yamagata K, Aldhoon B, Kautzner J. Reduction of Fluoroscopy Time and Radiation Dosage During Catheter Ablation for Atrial Fibrillation. Arrhythm Electrophysiol Rev 2016; 5:144-9. [PMID: 27617094 DOI: 10.15420/aer.2016.16.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Radiofrequency catheter ablation has become the treatment of choice for atrial fibrillation (AF) that does not respond to antiarrhythmic drug therapy. During the procedure, fluoroscopy imaging is still considered essential to visualise catheters in real-time. However, radiation is often ignored by physicians since it is invisible and the long-term risks are underestimated. In this respect, it must be emphasised that radiation exposure has various potentially harmful effects, such as acute skin injury, malignancies and genetic disease, both to patients and physicians. For this reason, every electrophysiologist should be aware of the problem and should learn how to decrease radiation exposure by both changing the setting of the system and using complementary imaging technologies. In this review, we aim to discuss the basics of X-ray exposure and suggest practical instructions for how to reduce radiation dosage during AF ablation procedures.
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Affiliation(s)
- Kenichiro Yamagata
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Bashar Aldhoon
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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Nedios S, Sommer P, Bollmann A, Hindricks G. Advanced Mapping Systems To Guide Atrial Fibrillation Ablation: Electrical Information That Matters. J Atr Fibrillation 2016; 8:1337. [PMID: 27909489 PMCID: PMC5089464 DOI: 10.4022/jafib.1337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/17/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022]
Abstract
Catheter ablation is an established and widespread treatment for atrial fibrillation (AF). Contemporary electroanatomical mapping systems (EAMs) have been developed to facilitate mapping processes but remain limited by spatiotemporal and processing restrictions. Advanced mapping systems emerged from the need to better understand and ablate complex AF substrate, by improving the acquisition and illustration of electrophysiological information. In this review, we present you the recently advanced mapping systems for AF ablation in comparison to the established contemporary EAMs.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
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Dieks JK, Müller MJ, Schneider HE, Krause U, Steinmetz M, Paul T, Kriebel T. Catheter Ablation of Pediatric Focal Atrial Tachycardia: Ten-Year Experience Using Modern Mapping Systems. Pediatr Cardiol 2016; 37:459-64. [PMID: 26538211 DOI: 10.1007/s00246-015-1299-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/20/2015] [Indexed: 11/25/2022]
Abstract
Experience of catheter ablation of pediatric focal atrial tachycardia (FAT) is still limited. There are data which were gathered prior to the introduction of modern 3D mapping and navigation systems into the clinical routine. Accordingly, procedures were associated with significant fluoroscopy and low success rates. The aim of this study was to present clinical and electrophysiological details of catheter ablation of pediatric FAT using modern mapping systems. Since March 2003, 17 consecutive patients <20 years underwent electrophysiological study (EPS) for FAT using the NavX(®) system (n = 7), the non-contact mapping system (n = 6) or the LocaLisa(®) system (n = 4), respectively. Radiofrequency was the primary energy source; cryoablation was performed in selected patients with a focus close to the AV node. In 16 patients, a total number of 19 atrial foci (right-sided n = 13, left-sided n = 6) could be targeted. In the remaining patient, FAT was not present/inducible during EPS. On an intention-to-treat basis, acute success was achieved in 14/16 patients (87.5 %) with a median number of 11 (1-31) energy applications. Ablation was unsuccessful in two patients due to an epicardial location of a right atrial focus (n = 1) and a focus close to the His bundle (n = 1), respectively. Median procedure time was 210 (84-332) min, and median fluoroscopy time was 13.1 (4.5-22.5) min. In pediatric patients with FAT, 3D mapping and catheter ablation provided improved clinical quality of care. Catheter ablation may be considered early in the course of treatment of this tachyarrhythmia in symptomatic patients.
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Affiliation(s)
- Jana-K Dieks
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany.
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Thomas Kriebel
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
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Hoffmann M, Brost A, Koch M, Bourier F, Maier A, Kurzidim K, Strobel N, Hornegger J. Electrophysiology Catheter Detection and Reconstruction From Two Views in Fluoroscopic Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:567-579. [PMID: 26441411 DOI: 10.1109/tmi.2015.2482539] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Electrophysiology (EP) studies and catheter ablation have become important treatment options for several types of cardiac arrhythmias. We present a novel image-based approach for automatic detection and 3-D reconstruction of EP catheters where the physician marks the catheter to be reconstructed by a single click in each image. The result can be used to provide 3-D information for enhanced navigation throughout EP procedures. Our approach involves two X-ray projections acquired from different angles, and it is based on two steps: First, we detect the catheter in each view after manual initialization using a graph-search method. Then, the detection results are used to reconstruct a full 3-D model of the catheter based on automatically determined point pairs for triangulation. An evaluation on 176 different clinical fluoroscopic images yielded a detection rate of 83.4%. For measuring the error, we used the coupling distance which is a more accurate quality measure than the average point-wise distance to a reference. For successful outcomes, the 2-D detection error was 1.7 mm ±1.2 mm. Using successfully detected catheters for reconstruction, we obtained a reconstruction error of 1.8 mm ±1.1 mm on phantom data. On clinical data, our method yielded a reconstruction error of 2.2 mm ±2.2 mm.
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Romero J, Lupercio F, Goodman-Meza D, Ruiz JC, Briceno DF, Fisher JD, Gross J, Ferrick K, Kim S, Di Biase L, Garcia MJ, Krumerman A. Electroanatomic mapping systems (CARTO/EnSite NavX) vs. conventional mapping for ablation procedures in a training program. J Interv Card Electrophysiol 2015; 45:71-80. [PMID: 26560500 DOI: 10.1007/s10840-015-0073-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Three-dimensional electroanatomic mapping (EAM) systems reduce radiation exposure when radio frequency catheter ablation (RFCA) procedures are performed by well-trained senior operators. Given the steep learning curve associated with complex RFCA, trainees and their mentors must rely on multiple imaging modalities to maximize safety and success, which might increase procedure and fluoroscopy times. The objective of the present study is to determine if 3-D EAM (CARTO and ESI-NavX) improves procedural outcomes (fluoroscopy time, radio frequency time, procedure duration, complication, and success rates) during CA procedures as compared to fluoroscopically guided conventional mapping alone in an academic teaching hospital. METHODS We analyzed a total of 1070 consecutive RFCA procedures over an 8-year period for fluoroscopic time stratified by ablation target and mapping system. Multivariate logistic regression and adjusted odds ratios were calculated for each variable. RESULTS No statistically significant differences in acute success rates were noted between conventional and 3-D mapping cases [CARTO (p = 0.68) or ESI-NavX (p = 0.20)]. Moreover, complication rates were also not significantly different between CARTO (p = 0.23) and ESI-NavX (p = 0.53) when compared to conventional mapping. Procedure, radio frequency, and fluoroscopy times were significantly longer with CARTO and ESI-NavX versus conventional mapping [fluoroscopy time: CARTO, 28.3 min; ESI, 28.5 min; and conventional, 24.3 min; p < 0.001)]. CONCLUSIONS The use of 3-D EAM systems during teaching cases significantly increases radiation exposure when compared with conventional mapping. These findings suggest a need to develop alternative training strategies that enhance confidence and safety during catheter manipulation and allow for reduced fluoroscopy and procedure times during RFCA.
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Affiliation(s)
- Jorge Romero
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Florentino Lupercio
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Goodman-Meza
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan Carlos Ruiz
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David F Briceno
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John D Fisher
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jay Gross
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kevin Ferrick
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Soo Kim
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario J Garcia
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew Krumerman
- Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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Schmidt EJ, Tse ZTH, Reichlin TR, Michaud GF, Watkins RD, Butts-Pauly K, Kwong RY, Stevenson W, Schweitzer J, Byrd I, Dumoulin CL. Voltage-based device tracking in a 1.5 Tesla MRI during imaging: initial validation in swine models. Magn Reson Med 2015; 71:1197-209. [PMID: 23580479 DOI: 10.1002/mrm.24742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Voltage-based device-tracking (VDT) systems are commonly used for tracking invasive devices in electrophysiological cardiac-arrhythmia therapy. During electrophysiological procedures, electro-anatomic mapping workstations provide guidance by integrating VDT location and intracardiac electrocardiogram information with X-ray, computerized tomography, ultrasound, and MR images. MR assists navigation, mapping, and radiofrequency ablation. Multimodality interventions require multiple patient transfers between an MRI and the X-ray/ultrasound electrophysiological suite, increasing the likelihood of patient-motion and image misregistration. An MRI-compatible VDT system may increase efficiency, as there is currently no single method to track devices both inside and outside the MRI scanner. METHODS An MRI-compatible VDT system was constructed by modifying a commercial system. Hardware was added to reduce MRI gradient-ramp and radiofrequency unblanking pulse interference. VDT patches and cables were modified to reduce heating. Five swine cardiac VDT electro-anatomic mapping interventions were performed, navigating inside and thereafter outside the MRI. RESULTS Three-catheter VDT interventions were performed at >12 frames per second both inside and outside the MRI scanner with <3 mm error. Catheters were followed on VDT- and MRI-derived maps. Simultaneous VDT and imaging was possible in repetition time >32 ms sequences with <0.5 mm errors, and <5% MRI signal-to-noise ratio (SNR) loss. At shorter repetition times, only intracardiac electrocardiogram was reliable. Radiofrequency heating was <1.5°C. CONCLUSION An MRI-compatible VDT system is feasible.
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Affiliation(s)
- Ehud J Schmidt
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Koutalas E, Rolf S, Dinov B, Richter S, Arya A, Bollmann A, Hindricks G, Sommer P. Contemporary Mapping Techniques of Complex Cardiac Arrhythmias - Identifying and Modifying the Arrhythmogenic Substrate. Arrhythm Electrophysiol Rev 2015; 4:19-27. [PMID: 26835095 PMCID: PMC4711490 DOI: 10.15420/aer.2015.4.1.19] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/12/2015] [Indexed: 12/16/2022] Open
Abstract
Cardiac electrophysiology has moved a long way forward during recent decades in the comprehension and treatment of complex cardiac arrhythmias. Contemporary electroanatomical mapping systems, along with state-of-the-art technology in the manufacture of electrophysiology catheters and cardiac imaging modalities, have significantly enriched our armamentarium, enabling the implementation of various mapping strategies and techniques in electrophysiology procedures. Beyond conventional mapping strategies, ablation of complex fractionated electrograms and rotor ablation in atrial fibrillation ablation procedures, the identification and modification of the underlying arrhythmogenic substrate has emerged as a strategy that leads to improved outcomes. Arrhythmogenic substrate modification also has a major role in ventricular tachycardia ablation procedures. Optimisation of contact between tissue and catheter and image integration are a further step forward to augment our precision and effectiveness. Hybridisation of existing technologies with a reasonable cost should be our goal over the next few years.
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Affiliation(s)
- Emmanuel Koutalas
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
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Bearl DW, Mill L, Kugler JD, Prusmack JL, Erickson CC. Visualization of Atrioventricular Nodal Reentry Tachycardia Slow Pathways Using Voltage Mapping for Pediatric Catheter Ablation. CONGENIT HEART DIS 2015; 10:E172-9. [DOI: 10.1111/chd.12252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- David W. Bearl
- Department of Pediatrics; Children's Hospital and Medical Center; Omaha Neb USA
- University of Nebraska Medical Center; Omaha Neb USA
| | - LuAnn Mill
- Department of Pediatrics; Children's Hospital and Medical Center; Omaha Neb USA
- University of Nebraska Medical Center; Omaha Neb USA
| | - John D. Kugler
- Department of Pediatrics; Children's Hospital and Medical Center; Omaha Neb USA
- University of Nebraska Medical Center; Omaha Neb USA
| | | | - Christopher C. Erickson
- Department of Pediatrics; Children's Hospital and Medical Center; Omaha Neb USA
- University of Nebraska Medical Center; Omaha Neb USA
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35
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Dello Russo A, Conti S, Al-Mohani G, Casella M, Pizzamiglio F, Carbucicchio C, Riva S, Fassini G, Moltrasio M, Tundo F, Zucchetti M, Majocchi B, Russo E, Marino V, Bologna F, Biase LD, Natale A, Tondo C. New Imaging Technologies To Characterize Arrhythmic Substrate. J Atr Fibrillation 2014; 7:1137. [PMID: 27957131 DOI: 10.4022/jafib.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/09/2014] [Accepted: 10/27/2014] [Indexed: 11/10/2022]
Abstract
The cornerstone of the new imaging technologies to treat complex arrhythmias is the electroanatomic (EAM) mapping. It is based on tissue characterization and in particular on determination of low potential region and dense scar definition. Recently, the identification of fractionated isolated late potentials increased the specificity of the information derived from EAM. In addition, non-invasive tools and their integration with EAM, such as cardiac magnetic resonance imaging and computed tomography scanning, have been shown to be helpful to characterize the arrhythmic substrate and to guide the mapping and the ablation. Finally, intracardiac echocardiography, known to be useful for several practical uses in the setting of electrophysiological procedures, it has been also demonstrated to provide important informations about the anatomical substrate and may have potential to identify areas of scarred myocardium.
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Affiliation(s)
- Antonio Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Sergio Conti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Ghaliah Al-Mohani
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Francesca Pizzamiglio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Stefania Riva
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Gaetano Fassini
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Massimo Moltrasio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Fabrizio Tundo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Benedetta Majocchi
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Vittoria Marino
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Fabrizio Bologna
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Luigi Di Biase
- St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Andrea Natale
- St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.,St. David's Medical Center , Cardiac Arrhythmia Institute, Austin Texas, USA
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Rolf S, Hindricks G, Sommer P, Richter S, Arya A, Bollmann A, Kosiuk J, Koutalas E. Electroanatomical mapping of atrial fibrillation: Review of the current techniques and advances. J Atr Fibrillation 2014; 7:1140. [PMID: 27957132 PMCID: PMC5135200 DOI: 10.4022/jafib.1140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 01/07/2023]
Abstract
The number of atrial fibrillation (AF) catheter ablations performed annually has been increasing exponentially in the western countries in the last few years. This is clearly related to technological advancements, which have greatly contributed to the improvements in catheter ablation of AF. In particular, state-of-the-art electroanatomical mapping systems have greatly facilitated mapping processes and have enabled complex AF ablation strategies. In this review, we outline contemporary and upcoming electroanatomical key technologies focusing on new mapping tools and strategies in the context of AF catheter ablation.
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Affiliation(s)
- Sascha Rolf
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Gerhard Hindricks
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Philipp Sommer
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Sergio Richter
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Arash Arya
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Andreas Bollmann
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Jedrzej Kosiuk
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Emmanuel Koutalas
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
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Palamara S, Vergara C, Catanzariti D, Faggiano E, Pangrazzi C, Centonze M, Nobile F, Maines M, Quarteroni A. Computational generation of the Purkinje network driven by clinical measurements: the case of pathological propagations. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:1558-77. [PMID: 25319252 DOI: 10.1002/cnm.2689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 05/16/2023]
Abstract
To properly describe the electrical activity of the left ventricle, it is necessary to model the Purkinje fibers, responsible for the fast and coordinate ventricular activation, and their interaction with the muscular propagation. The aim of this work is to propose a methodology for the generation of a patient-specific Purkinje network driven by clinical measurements of the activation times related to pathological propagations. In this case, one needs to consider a strongly coupled problem between the network and the muscle, where the feedback from the latter to the former cannot be neglected as in a normal propagation. We apply the proposed strategy to data acquired on three subjects, one of them suffering from muscular conduction problems owing to a scar and the other two with a muscular pre-excitation syndrome (Wolff-Parkinson-White). To assess the accuracy of the proposed method, we compare the results obtained by using the patient-specific Purkinje network generated by our strategy with the ones obtained by using a non-patient-specific network. The results show that the mean absolute errors in the activation time is reduced for all the cases, highlighting the importance of including a patient-specific Purkinje network in computational models.
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Affiliation(s)
- Simone Palamara
- Modellistica e Calcolo Scientifico (MOX), Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
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Patient-specific generation of the Purkinje network driven by clinical measurements of a normal propagation. Med Biol Eng Comput 2014; 52:813-26. [PMID: 25151397 DOI: 10.1007/s11517-014-1183-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
The propagation of the electrical signal in the Purkinje network is the starting point for the activation of the ventricular muscular cells leading to the contraction of the ventricle. In the computational models, describing the electrical activity of the ventricle is therefore important to account for the Purkinje fibers. Until now, the inclusion of such fibers has been obtained either by using surrogates such as space-dependent conduction properties or by generating a network based on an a priori anatomical knowledge. The aim of this work was to propose a new method for the generation of the Purkinje network using clinical measures of the activation times on the endocardium related to a normal electrical propagation, allowing to generate a patient-specific network. The measures were acquired by means of the EnSite NavX system. This system allows to measure for each point of the ventricular endocardium the time at which the activation front, that spreads through the ventricle, has reached the subjacent muscle. We compared the accuracy of the proposed method with the one of other strategies proposed so far in the literature for three subjects with a normal electrical propagation. The results showed that with our method we were able to reduce the absolute errors, intended as the difference between the measured and the computed data, by a factor in the range 9-25 %, with respect to the best of the other strategies. This highlighted the reliability of the proposed method and the importance of including a patient-specific Purkinje network in computational models.
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Villongco CT, Krummen DE, Stark P, Omens JH, McCulloch AD. Patient-specific modeling of ventricular activation pattern using surface ECG-derived vectorcardiogram in bundle branch block. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:305-13. [PMID: 25110279 DOI: 10.1016/j.pbiomolbio.2014.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
Abstract
Patient-specific computational models have promise to improve cardiac disease diagnosis and therapy planning. Here a new method is described to simulate left-bundle branch block (LBBB) and RV-paced ventricular activation patterns in three dimensions from non-invasive, routine clinical measurements. Activation patterns were estimated in three patients using vectorcardiograms (VCG) derived from standard 12-lead electrocardiograms (ECG). Parameters of a monodomain model of biventricular electrophysiology were optimized to minimize differences between the measured and computed VCG. Electroanatomic maps of local activation times measured on the LV and RV endocardial surfaces of the same patients were used to validate the simulated activation patterns. For all patients, the optimal estimated model parameters predicted a time-averaged mean activation dipole orientation within 6.7 ± 0.6° of the derived VCG. The predicted local activation times agreed within 11.5 ± 0.8 ms of the measured electroanatomic maps, on the order of the measurement accuracy.
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Affiliation(s)
| | - David E Krummen
- Department of Medicine (Cardiology), University of California, San Diego, CA 92093, USA; US Department of Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Paul Stark
- Department of Radiology, University of California, San Diego, CA 92093, USA; US Department of Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Jeffrey H Omens
- Department of Bioengineering, University of California, La Jolla, CA 92093, USA; Department of Medicine (Cardiology), University of California, San Diego, CA 92093, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California, La Jolla, CA 92093, USA; Department of Medicine (Cardiology), University of California, San Diego, CA 92093, USA.
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Eitel C, Hindricks G, Grothoff M, Gutberlet M, Sommer P. Catheter Ablation Guided by Real-Time MRI. Curr Cardiol Rep 2014; 16:511. [DOI: 10.1007/s11886-014-0511-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kircher S, Rolf S, Hindricks G, Sommer P. Ablation of typical atrial flutter using a novel non-fluoroscopic electromagnetic catheter tracking system. Interv Cardiol 2014. [DOI: 10.2217/ica.14.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Eitel C, Hindricks G, Dagres N, Sommer P, Piorkowski C. EnSite Velocity™ cardiac mapping system: a new platform for 3D mapping of cardiac arrhythmias. Expert Rev Med Devices 2014; 7:185-92. [DOI: 10.1586/erd.10.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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VALDERRABANO MIGUEL, GREENBERG STEVEN, RAZAVI HEDI, MORE ROHAN, RYU KYUNGMOO, HEIST EKEVIN. 3D Cardiovascular Navigation System: Accuracy and Reduction in Radiation Exposure in Left Ventricular Lead Implant. J Cardiovasc Electrophysiol 2013; 25:87-93. [DOI: 10.1111/jce.12290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/09/2013] [Accepted: 08/02/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - E. KEVIN HEIST
- Massachusetts General Hospital; Boston Massachusetts USA
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AHMAD GHADA, HUSSEIN AYMANA, MESUBI OLUROTIMI, TIAN JING, FERIEG HANAA, ELMAATY MERVATA, HAMDY AMAL, EGO-OSUALA KELECHI, JIMENEZ ALEJANDRO, SEE VINCENT, SALIARIS ANASTASIOS, SHOROFSKY STEPHEN, DICKFELD TIMM. Impact of Fluoroscopy Unit on the Accuracy of a Magnet-Based Electroanatomic Mapping and Navigation System: AnIn VitroandIn VivoValidation Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:157-63. [DOI: 10.1111/pace.12231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/06/2013] [Accepted: 06/11/2013] [Indexed: 11/27/2022]
Affiliation(s)
- GHADA AHMAD
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - AYMAN A. HUSSEIN
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - OLUROTIMI MESUBI
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - JING TIAN
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - HANAA FERIEG
- Department of Cardiology, Al-Azhar University; Cairo Egypt
| | | | - AMAL HAMDY
- Department of Cardiology, Al-Azhar University; Cairo Egypt
| | - KELECHI EGO-OSUALA
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - ALEJANDRO JIMENEZ
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - VINCENT SEE
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - ANASTASIOS SALIARIS
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - STEPHEN SHOROFSKY
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
| | - TIMM DICKFELD
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG); Division of Cardiology, University of Maryland; Baltimore Maryland
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Pires LM, Leiria TLL, Kruse ML, Ronsoni R, Gensas CS, de Lima GG. Catheter ablation of arrhythmias exclusively using electroanatomic mapping: a series of cases. Arq Bras Cardiol 2013; 101:226-32. [PMID: 23877742 PMCID: PMC4032302 DOI: 10.5935/abc.20130147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 04/26/2013] [Indexed: 11/20/2022] Open
Abstract
Background Catheter ablation is a treatment that can cure various cardiac arrhythmias.
Fluoroscopy is used to locate and direct catheters to areas that cause
arrhythmias. However, fluoroscopy has several risks. Electroanatomic mapping (EAM)
facilitates three-dimensional imaging without X-rays, which reduces risks
associated with fluoroscopy. Objective We describe a series of patient cases wherein cardiac arrhythmia ablation was
exclusively performed using EAM. Methods Patients who presented with cardiac arrhythmias that were unresponsive to
pharmacological therapy were prospectively selected between March 2011 and March
2012 for arrhythmia ablation exclusively through EAM. Patients with indications
for a diagnostic electrophysiology study and ablation of atrial fibrillation, left
atrial tachyarrhythmias as well as hemodynamically unstable ventricular arrhythmia
were excluded. We documented the procedure time, success rate and complications as
well as whether fluoroscopy was necessary during the procedure. Results In total, 11 patients were enrolled in the study, including seven female patients
(63%). The mean age of the patients was 50 years (SD ±16.5). Indications for the
investigated procedures included four cases (35%) of atrial flutter, three cases
(27%) of pre-excitation syndrome, two cases (19%) of paroxysmal supraventricular
tachycardia and two cases (19%) of ventricular extrasystoles. The mean procedure
duration was 86.6 min (SD ± 26 min). Immediate success (at discharge) of the
procedure was evident for nine patients (81%). There were no complications during
the procedures. Conclusion This study demonstrates the feasibility of performing an arrhythmia ablation
exclusively using EAM with satisfactory results.
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Affiliation(s)
| | | | | | | | | | - Gustavo Glotz de Lima
- Mailing Address: Gustavo Glotz de Lima, Av. Princesa Isabel, 370,
Santana. Postal Code 90620-000, Porto Alegre, RS - Brazil. E-mail:
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Cronin EM, Wisnoskey BJ, Rizzo RA, Niebauer MJ, Dresing TJ, Cantillon DJ. Real-time guidewire localization using impedance-based electroanatomic mapping: experimental results and clinical validation during cryoballoon ablation of atrial fibrillation. Europace 2013; 15:1669-76. [PMID: 23736804 DOI: 10.1093/europace/eut144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Cryoballoon ablation is an emerging therapy for atrial fibrillation (AF). However, the Arctic Front cryoballoon (Medtronic) cannot be localized on current electroanatomic mapping (EAM) systems. We describe a technique to visualize guidewires in an impedance-based EAM system. METHODS AND RESULTS A novel technique for real-time guidewire localization in an EAM (Ensite Velocity, St Jude Medical) was prospectively evaluated among patients referred for cryoballoon AF ablation. The guidewire was visualized as an 'orb' on the EAM and localization in each of the pulmonary veins (PVs) compared with orthogonal fluoroscopy, contrast venography, and intra-cardiac echocardiography. Application of the technique in 21 consecutive patients [median age 58 (interquartile range 21); 71.4% male; 85.7% paroxysmal AF] demonstrated agreement with respect to guidewire localization in 82 of 82 (100%) PVs. Discrimination of guidewire position in the left atrial appendage from the left PVs was also demonstrated. When compared with 21 consecutive cryoballoon procedures over the same time period in which the technique was not used, fluoroscopy time was reduced [median 53.2 (25.9) vs. 72.3 (47.6) min, P = 0.008], and a trend towards reduced radiation exposure [median 372 (656.0) vs. 581 (849.9) mGy, P = 0.08] was noted, without effect on acute procedural or mid-term endpoints. Ex vivo assessment of the technique in a saline bath left atrial model demonstrated that the 'orb' localizes to the centroid of the exposed portion of the guidewire. CONCLUSION This simple, novel technique provides real-time, accurate guidewire localization to enable guidewire and catheter navigation during cryoballoon AF ablation.
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Radbill AE, Fish FA. Mapping and ablation of supraventricular tachycardia in pediatric and congenital heart disease patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2013. [DOI: 10.1016/j.ppedcard.2012.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sommer P, Wojdyla-Hordynska A, Rolf S, Gaspar T, Eitel C, Arya A, Hindricks G, Piorkowski C. Initial experience in ablation of typical atrial flutter using a novel three-dimensional catheter tracking system. ACTA ACUST UNITED AC 2012; 15:578-81. [DOI: 10.1093/europace/eus226] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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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 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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Kerst G, Parade U, Weig HJ, Hofbeck M, Gawaz M, Schreieck J. A novel technique for zero-fluoroscopy catheter ablation used to manage Wolff-Parkinson-White syndrome with a left-sided accessory pathway. Pediatr Cardiol 2012; 33:820-3. [PMID: 22367551 DOI: 10.1007/s00246-012-0207-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 12/09/2011] [Indexed: 11/25/2022]
Abstract
Conventional catheter ablation of cardiac arrhythmias is associated with the potential adverse effects of low-dose ionizing radiation on both patients and laboratory personnel. Due to the greater radiation sensitivity and the longer life expectancy of children, reduction of radiation exposure for them is of particular importance. A novel technique for zero-fluoroscopy catheter ablation is described using real-time tissue-tip contact force measurements for a 10-year-old boy who had Wolff-Parkinson-White syndrome with a left-sided accessory pathway.
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Affiliation(s)
- Gunter Kerst
- Department of Pediatric Cardiology, University Hospital Tübingen, Hoppe-Seyler-Str 1, 72076 Tübingen, Germany.
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