Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation: Arrhythmia and Electrophysiology
Search: search_blue_button Advanced Search
Circulation: Arrhythmia and Electrophysiology. 2008;1:110-119
Published online before print April 30, 2008, doi: 10.1161/CIRCEP.108.769935
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
1/2/110    most recent
CIRCEP.108.769935v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Okumura, Y.
Right arrow Articles by Packer, D. L.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Okumura, Y.
Right arrow Articles by Packer, D. L.
Related Collections
Right arrow Ablation/ICD/surgery
Right arrowRelated Articles

Original Articles

Three-Dimensional Ultrasound for Image-Guided Mapping and Intervention

Methods, Quantitative Validation, and Clinical Feasibility of a Novel Multimodality Image Mapping System

Yasuo Okumura, MD, PhD; Benhur D. Henz, MD; Susan B. Johnson, BS; T. Jared Bunch, MD; Christine J. O’Brien; David O. Hodge, MS; Andres Altman; Assaf Govari and Douglas L. Packer, MD

From the Translational Cardiac Electrophysiology Laboratory (Y.O., B.D.H., S.B.J., T.J.B., C.J.O., D.L.P.), Division of Cardiovascular Disease, Department of Internal Medicine, Health Sciences Research (D.O.H.), Mayo Clinic, Rochester, Minn.; and Biosense Webster (A.A., A.G.), Diamond Bar, Calif.

Correspondence to Douglas L. Packer, MD, 2-416 Alfred Building, Saint Mary’s Hospital Complex, Mayo Foundation, Rochester, MN 55902. E-mail packer.douglas{at}mayo.edu

Received September 18, 2007; accepted April 7, 2008.

Background— Multiple factors create discrepancies between electroanatomic maps and merged, preacquired computed tomographic images used in guiding atrial fibrillation ablation. Therefore, a Carto-based 3D ultrasound image system (Biosense Webster Inc) was validated in an animal model and tested in 15 atrial fibrillation 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 images, were constructed. Point-source error of 3D ultrasound-derived geometries, assessed by actual real-time 2D intracardiac echocardiographic clip sites, was 2.1±1.1 mm for atrial and 2.4±1.2 mm for ventricular sites. These errors were significantly less than the variance on CartoMerge computed tomographic 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 ablation guided by 3D ultrasound-derived geometry resulted in circumferential ablative lesions. Mapping in 15 patients produced modestly smaller 3D ultrasound versus electroanatomic map left atrial volumes (98±24 cm3 versus 109±25 cm3, P<0.05). Three-dimensional ultrasound-guided pulmonary vein isolation and linear ablation in these patients were successfully performed with confirmation of pulmonary vein entrance/exit block.

Conclusions— 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 computed tomographic imaging. This clinical study also demonstrates the initial feasibility of this guidance system for ablation in patients with atrial fibrillation.

Key Words: ablation • mapping • 3D ultrasound imaging


 

CLINICAL PERSPECTIVE


Related Articles

Atrial Arrhythmias After Single-Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation: Mechanisms and Management
Toon Wei Lim, Choon Hiang Koay, Rebecca McCall, Valerie A. See, David L. Ross, and Stuart P. Thomas
Circ Arrhythmia Electrophysiol 2008 1: 120-126. [Abstract] [Full Text] [PDF]

Altered Sympathetic Nervous Reactivity and Norepinephrine Transporter Expression in Patients With Postural Tachycardia Syndrome
Elisabeth Lambert, Nina Eikelis, Murray Esler, Tye Dawood, Markus Schlaich, Richard Bayles, Flora Socratous, Alex Agrotis, Garry Jennings, Gavin Lambert, and Gautam Vaddadi
Circ Arrhythmia Electrophysiol 2008 1: 103-109. [Abstract] [Full Text] [PDF]

Atrial Arrhythmias After Single-Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation: Mechanisms and Management
Toon Wei Lim, Choon Hiang Koay, Rebecca McCall, Valerie A. See, David L. Ross, and Stuart P. Thomas
Circ Arrhythmia Electrophysiol 2008 1: 120-126. [Abstract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
EuropaceHome page
E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al.
EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA)
Europace, June 1, 2009; 11(6): 771 - 817.
[Full Text] [PDF]


Home page
J Am Coll Cardiol ImgHome page
L. F. Tops and J. J. Bax
The Year in Imaging Related to Electrophysiology
J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 498 - 510.
[Full Text] [PDF]


Home page
CirculationHome page
Z. M. Hijazi, K. Shivkumar, and D. J. Sahn
Intracardiac Echocardiography During Interventional and Electrophysiological Cardiac Catheterization
Circulation, February 3, 2009; 119(4): 587 - 596.
[Full Text] [PDF]