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Europace Advance Access originally published online on June 23, 2008
Europace 2008 10(8):939-948; doi:10.1093/europace/eun147
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions©oxfordjournals.org.

Ablation of atrial fibrillation

Computed tomography model-based treatment of atrial fibrillation and atrial macro-re-entrant tachycardia

Christopher Piorkowski*, Simon Kircher, Arash Arya, Thomas Gaspar, Masahiro Esato, Sam Riahi, Andreas Bollmann, Daniela Husser, Charlotte Staab, Philipp Sommer and Gerhard Hindricks

Department of Electrophysiology, University of Leipzig, Heart Center, Strümpellstrasse 39, 04289 Leipzig, Germany

Aims: Accurate orientation within true three-dimensional (3D) anatomies is essential for the successful radiofrequency (RF) catheter ablation of atrial fibrillation (AF) and atrial macro-re-entrant tachycardia (MRT). In this prospective study, ablation of AF and MRT was performed exclusively using a pre-acquired and integrated computed tomography (CT) image for anatomical 3D orientation without electro-anatomic reconstruction of the left atrium (LA).

Methods and results: Fifty-four consecutive patients suffering from AF (n = 36) and/or MRT (n = 18) underwent RF catheter ablation. A 3D CT image was registered into the NavX-Ensite system without reconstruction of the atrial chamber anatomy. The quality of CT alignment was assessed and validated according to fluoroscopy information, electrogram characteristics, and tactile feedback at 31 pre-defined LA control points. The ablation of AF as well as mapping and ablation of MRT was performed within the 3D CT anatomy. In all patients, mapping and ablation could be performed without the reconstruction of the respective atrial chamber anatomy. The overall CT alignment was highly accurate with true surface contact in 90% (84%; 100%) of the control points. Complete isolation of all pulmonary vein (PV) funnels was achieved in 35 of 36 patients (97%) with AF. In patients with persistent AF (n = 11), additional isolation of the posterior LA (box lesion) and the placement of a mitral isthmus line were performed. The MRT mechanisms were as follows: around a PV ostium (n = 6), perimitral (n = 4), through LA roof (n = 5), septal (n = 2), and around left atrial appendage (n = 1). After a follow-up of 122 ± 33 days, 22/25 (88%) patients with paroxysmal AF, 8/11 (73%) with persistent AF, and 16/18 (89%) with MRT remained free from arrhythmia recurrences.

Conclusion: For patients with AF and MRT, our study shows the feasibility of successful placement of complex linear ablation line concepts guided by an integrated 3D image anatomy alone rather than catheter-based virtual chamber surface reconstructions.

Key Words: Atrial fibrillation, Ablation, Three dimensional image, Model-guided therapy

* Corresponding author. Tel: +49 341 8651413; fax: +49 341 8651460. E-mail address: cp7026{at}yahoo.de

Manuscript submitted 2 February 2008. Accepted after revision 12 May 2008.


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