Using Pre-Procedure Imaging and Simulation of Drawing Ablation Line to Improve Patient Outcomes in Pulmonary Vein Isolation

概要

論文の詳細を見る
The detailed patient-specific anatomical information may greatly assist catheter ablation of atrial fibrillation (AF). We refer to images from left atrium (LA)-pulmonary vein (PV) angiography, fluoroscopy, and multi-detector computed tomography (MDCT) during procedure using three-dimensional mapping system tagging ablation point without reconstruction. The problems with pulmonary vein isolation include a relatively long fluoroscopic time and incomplete understanding of the complicated LA-PV anatomy especially LA-LAA ridge running anterior left PV. We developed LA-PV translucent volume-rendering image by MDCT with esophagus and vertebral body and drawing ideal ablation lines and display during procedure, from any direction and 4 different views simultaneously. We compared the procedure time, radiation exposure, and result of PV isolation with (n=59) or without (n=62) pre-procedure ablation line. It resulted in a significant reduction of operating-room time (4 hours 4 minutes vs. 4 hours 39 minutes) and radiation exposure (2557 vs. 3167 mGy) and improve outcome (free from atrial fibrillation 68% vs. 63% after first procedure). In conclusions, pre-procedural MDCT imaging with ideal ablation lines can be used as an accurate method to guide AF ablation procedures. The use of this method substantially reduced total patient radiation dose without a relevant reduction in mapping accuracy and outcome.