Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Pulmonary vein isolation (PVI) by catheter ablation is a cornerstone treatment of paroxysmal AF. Low success rates are mainly due to reconnecting tissue. Local myocardial wall-thickness (WT) information is missing; lesion transmurality is impossible to estimate. WT information can be obtained from pencil beam high-resolution MRI, a time-consuming protocol. To reduce scan time, automatic selection of regions of interest is proposed. We developed a left atrial target probability model for paroxysmal AF ablation, based on intraprocedural ablation targeting data of fifteen patients, to support the selection of these regions. A common mesh serves as a reference for registration of the electroanatomical meshes and ablation targets using landmark registration and the Iterative Closest Points algorithm. This is followed by projection of the ablation targets onto the mean mesh model, closure of isolated ablation voids on the surface and Gaussian smoothing of the probability distribution.
The final probability distribution clearly shows PVI contours as suggested in the consensus statement by European associations. The right inferior pulmonary vein (RIPV) shows a lower ablation probability, which may be due to limited maneuverability of the ablation catheter and the proximity of the RIPV ostium and the transseptal puncture, where the catheter enters the left atrium.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Feinberg, W.M., Blackshear, J.L., Laupacis, A., Kronmal, R., Hart, R.G.: Prevalence, age distribution, and gender of patients with atrial fibrillation. analysis and implications. Arch. Intern. Med. 155(5), 469–473 (1995)
Allessie, M., Ausma, J., Schotten, U.: Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc. Res. 54(2), 230–246 (2002)
European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm, A.J., Kirchhof, P., Lip, G.Y.H., Schotten, U., Savelieva, I., Ernst, S., Van Gelder, I.C., Al-Attar, N., Hindricks, G., Prendergast, B., Heidbuchel, H., Alfieri, O., Angelini, A., Atar, D., Colonna, P., De Caterina, R., De Sutter, J., Goette, A., Gorenek, B., Heldal, M., Hohloser, S.H., Kolh, P., Le Heuzey, J.Y., Ponikowski, P., Rutten, F.H.: Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the european society of cardiology (ESC). Eur. Heart J. 31(19), 2369–2429 (2010)
Nademanee, K., McKenzie, J., Kosar, E., Schwab, M., Sunsaneewitayakul, B., Vasavakul, T., Khunnawat, C., Ngarmukos, T.: A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J. Am. Coll. Cardiol. 43(11), 2044–2053 (2004)
Calkins, H., Cappato, R., Brugada, J., et al.: 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 9(4), 632–696 (2012)
Ouyang, F., Tilz, R., Chun, J., Schmidt, B., Wissner, E., Zerm, T., Neven, K., Köktürk, B., Konstantinidou, M., Metzner, A., Fuernkranz, A., Kuck, K.H.: Long-term results of catheter ablation in paroxysmal atrial fibrillation: Lessons from a 5-year follow-up. Circulation 122(23), 2368–2377 (2010)
Stevenhagen, J., Van Der Voort, P.H., Dekker, L.R.C., Bullens, R.W.M., Van Den Bosch, H., Meijer, A.: Three-dimensional ct overlay in comparison to cartomerge for pulmonary vein antrum isolation. J. Cardiovasc. Electrophysiol. 21(6), 634–639 (2010)
Akoum, N., Daccarett, M., McGann, C., Segerson, N., Vergara, G., Kuppahally, S., Badger, T., Burgon, N., Haslam, T., Kholmovski, E., Macleod, R., Marrouche, N.: Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a de-mri guided approach. J. Cardiovasc. Electrophysiol. 22(1), 16–22 (2011)
Jumrussirikul, P., Atiga, W.L., Lardo, A.C., Berger, R.D., Halperin, H., Hutchins, G.M., Calkins, H.: Prospective comparison of lesions created using a multipolar microcatheter ablation system with those created using a pullback approach with standard radiofrequency ablation in the canine atrium. Pacing. Clin. Electrophysiol. 23(2), 203–213 (2000)
Ouyang, F., Antz, M., Ernst, S., Hachiya, H., Mavrakis, H., Deger, F.T., Schaumann, A., Chun, J., Falk, P., Hennig, D., Liu, X., Bänsch, D., Kuck, K.H.: Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double lasso technique. Circulation 111(2), 127–135 (2005)
Koken, P., Holthuizen, R., Krueger, S., Heese, H.S., Weiss, S., Smink, J., Razavi, R., Schaeffter, T.: Atrial thickness mapping for ep ablation using black-blood restricted field of view mri. In: Proceedings 19th ISMRM Scientific Meeting, Montréal, Canada (2011)
Pappone, C., Vicedomini, G., Manguso, F., Gugliotta, F., Mazzone, P., Gulletta, S., Sora, N., Sala, S., Marzi, A., Augello, G., Livolsi, L., Santagostino, A., Santinelli, V.: Robotic magnetic navigation for atrial fibrillation ablation. J. Am. Coll. Cardiol. 47(7), 1390–1400 (2006)
Pfeifer, B., Hanser, F., Trieb, T., Hintermüller, C., Seger, M., Fischer, G., Modre, R., Tilg, B.: Combining active appearance models and morphological operators using a pipeline for automatic myocardium extraction. In: Frangi, A.F., Radeva, P., Santos, A., Hernandez, M. (eds.) FIMH 2005. LNCS, vol. 3504, pp. 44–53. Springer, Heidelberg (2005)
Koppert, M.M.J., Rongen, P.M.J., Prokop, M., ter Haar Romeny, B.M., van Assen, H.C.: Cardiac left atrium CT image segmentation for ablation guidance. In: IEEE International Symposium on Biomedical Imaging: From Nano to Macro, ISBI 2010, pp. 480–483, April 2010
Sanchez-Quintana, D., Cabrera, J., Climent, V., Farre, J., Mendonca, M., Ho, S.: Anatomic relations between the esophagus and left atrium and relevance for ablation of atrial fibrillation. Circulation 112(10), 1400–1405 (2005)
Hall, B., Jeevanantham, V., Simon, R., Filippone, J., Vorobiof, G., Daubert, J.: Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation. J. Interv. Card. Electr. 17(2), 127–132 (2006)
Zhang, Z.: Iterative point matching for registration of free-form curves and surfaces. International Journal of Computer Vision 13(2), 119–152 (1994)
Peters, J., Ecabert, O., Meyer, C., Schramm, H., Kneser, R., Groth, A., Weese, J.: Automatic whole heart segmentation in static magnetic resonance image volumes. Med. Image. Comput. Comput. Assist. Interv. 10(Pt 2), 402–410 (2007)
Jayender, J., Patel, R.V., Michaud, G.F., Hata, N.: Optimal transseptal puncture location for robot-assisted left atrial catheter ablation. In: Yang, G.-Z., Hawkes, D., Rueckert, D., Noble, A., Taylor, C. (eds.) MICCAI 2009, Part I. LNCS, vol. 5761, pp. 1–8. Springer, Heidelberg (2009)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this paper
Cite this paper
Al-Agamy, A. et al. (2015). Statistical Model of Paroxysmal Atrial Fibrillation Catheter Ablation Targets for Pulmonary Vein Isolation. In: Camara, O., Mansi, T., Pop, M., Rhode, K., Sermesant, M., Young, A. (eds) Statistical Atlases and Computational Models of the Heart - Imaging and Modelling Challenges. STACOM 2014. Lecture Notes in Computer Science(), vol 8896. Springer, Cham. https://doi.org/10.1007/978-3-319-14678-2_23
Download citation
DOI: https://doi.org/10.1007/978-3-319-14678-2_23
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-14677-5
Online ISBN: 978-3-319-14678-2
eBook Packages: Computer ScienceComputer Science (R0)