Abstract 2341: Intracardiac Echo for Registration of Rotational Angiography Based Left Atrial Reconstructions: A Novel Approach Integrating Two Intraprocedural 3D Imaging Techniques in Atrial Fibrillation Ablation
Background: Image integration of 3D reconstructions (RC) in electroanatomical mapping (EAM) plays a major role in atrial fibrillation (AF) ablation. Point-by-point EAM is commonly used for registration of imported left atrial (LA) and pulmonary vein (PV) anatomy. The aim of this study was to quantify the accuracy of intraprocedural rotational angiography (RA) based LA and PV RC registered by spatial RC of intracardiac echocardiography (ICE).
Methods: 22 patients (11 male, 66±12 years) were studied. Reconstructions of the LA and PV based on RA were transferred to the EAM system and registered by a second 3D reconstruction based on ICE (Fig⇓). In a second step EAM points were added to the ICE reconstructions.
Results: All PV were isolated successfully. 3D reconstructions of the LA and PV were feasible in every patient by both modalities. RA-based LA reconstruction took 11.5±5.2 minutes. ICE reconstruction took 20.4±11.2 minutes, 17±6 2D-echo fans were needed. Deviation of ICE reconstructions and RA-based reconstructions was 2.6±0.5 mm. Integration of 78±58 EAM points into ICE reconstructions did not significantly improve the deviation to RA-based reconstructions (2.7±0.6 mm).
Conclusions: Intraprocedural 3D reconstruction of LA and PV for ablation of AF is feasible based on RA as well as based on ICE. Registration of LA reconstructions based on RA by 3D ICE reconstructions is feasible. Deviation between the two modalities is minimal and can not be improved by integration of additional EAM points into the 3D ICE reconstructions. Left panel: ICE based 3D reconstructions of LA, LA appendage and PV. Right panel: 3D RC of LA, PV and LAA based on RA. An additional EAM of the LA is depicted in red.