Published Online
on April 30, 2008

A more recent version of this article appeared on June 1, 2008

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Original Article

Three-Dimensional Ultrasound for Image-Guided Mapping and Intervention: Methods, Quantitative Validation and Clinical Feasibility of a Novel Multi-Modality Image Mapping System

Yasuo Okumura¹, Benhur D. Henz¹, Susan B. Johnson¹, T. Jared Bunch², Christine J. O'Brien², David O. Hodge², Andres Altman³, Assaf Govari³ and Douglas L. Packer^1,4

¹ Mayo Clinic - Rochester;
² Mayo Clinic-Rochester;
³ Biosense Webster, Inc.

Correspondence: ⁴ E-mail: packer{at}mayo.edu

Background—Multiple factors create discrepancies between electro-anatomic maps and merged, pre-acquired CT images used in guiding atrial fibrillation (AF) ablation. Therefore, a Carto-based 3D ultrasound image system was validated in an animal model and tested in 15 AF patients.

Methods and Results—Twelve dogs underwent evaluation using a newly developed Carto-based 3D ultrasound system. After fiducial clip markers were percutaneously implanted at critical locations in each cardiac chamber, 3D ultrasound geometries, derived from a family of 2D intracardiac echocardiographic (ICE) images, were constructed. Point-source error of 3D ultrasound-derived geometries, assessed by derived 3D ultrasound and actual real-time 2D ICE clip sites, was 2.1±1.1 mm atrial and 2.4±1.2 mm ventricular sites. These errors were significantly less than the variance on CartoMerge CT images (atria: 3.3±1.6 mm, ventricles: 4.8±2.0 mm, p<0.001 for both). Target ablation at each clip, guided only by 3D ultrasound derived-geometry, resulted in lesions within 1.1±1.1 mm of the actual clips. Pulmonary vein (PV) ablation guided by 3D ultrasound derived-geometry resulted in circumferential ablative lines. Mapping in 15 patients produced modestly smaller 3D ultrasound-vs-electroanatomic map LA volumes (98±24 cm³ vs. 109±25 cm³, p<0.05). 3D ultrasound-guided PV isolation and linear ablation in these patients were successfully performed with confirmation of PV entrance/exit block.

Conclusion—These data demonstrate that 3D ultrasound images seamlessly yield anatomically accurate chamber geometries. Image volumes from the ultrasound system are more accurate than possible with CartoMerge CT imaging. This clinical study also demonstrates the initial feasibility of this guidance system for ablation in patients with AF.

Key Words: ablation • mapping • 3D ultrasound imaging • atrial fibrillation

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