Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach

Klaus Kettering, Gerald F. Greil, Michael Fenchel, Ulrich Kramer, Hans Joerg Weig, Mathias Busch, Stephan Miller, Ludger Sieverding, Roman Laszlo, Juergen Schreieck

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug refractory atrial fibrillation. However, catheter ablation of atrial fibrillation is still a challenge. This is partially due to the high degree of variability with regard to the individual anatomy. Nevertheless, 3D imaging systems (CT, MRI) provide detailed information about the individual left atrial and pulmonary vein morphology. A 3D CT or MRI reconstruction of the left atrium can be displayed in the Navx-/Ensite-system in a synchronised way during the ablation procedure, thereby facilitating the intervention. This study summarizes our preliminary experience with different strategies of AF ablation using the Navx-/Ensite-system and a CT-/MRI-guided approach. Methods: In a total of 41 patients, cardiac MRI (n = 7) or multi-detector spiral computed tomography (n = 34) was performed prior to an ablation procedure. Catheter ablation was performed for paroxysmal atrial fibrillation in 31 patients and for persistent atrial fibrillation in 10 patients. A 3D MRI or high resolution spiral CT data acquisition was performed and a surface rendered model of the LA was created. This model was displayed in the Navx-/Ensite-system throughout the ablation procedure. Results: Catheter ablation was performed using the Navx-system (n = 38) or the Ensite-system (n = 3). Three strategies were used depending on the type of atrial fibrillation: segmental isolation of the pulmonary veins (facilitated by a 3D real-time visualization of the ablation catheter and a circumferential mapping catheter; group A: 20 patients), linear lesions (group C: 3 patients) and a combined approach (group B; 18 patients). The CT-/MRI-models provided an excellent overview over the pulmonary veins and the left atrial appendage. They revealed a high degree of variability with regard to the individual anatomy (e.g. dimensions of the left atrial appendage, pulmonary vein ostia). The CT scans provided a more detailed reconstruction of the left atrial anatomy than the MRI scans (especially in patients who were in atrial fibrillation at the time of the data acquisition). In some patients, the CT-/MRI-models revealed a very small diameter of some pulmonary veins or side branches close to the ostium (e.g. right inferior pulmonary vein). Therefore, no attempt was made to achieve complete pulmonary vein isolation in some patients. In group A, 16/20 (80%) patients had no arrhythmia recurrence [mean follow-up 359 days (SD ± 317 days)]. Twelve out of eighteen (67%) patients in group B [mean follow-up 452 days (SD ± 311 days)] and 2/3 (67%) patients in group C did not experience an arrhythmia recurrence [mean follow-up 1,000 days (SD ± 34 days)]. There were no major complications. Conclusions: The information derived from 3D CT- or MRI-reconstructions facilitates AF ablations performed with the Navx-/Ensite-mapping system and enhances the safety of these procedures. Furthermore, the availability of an additional impedance-based 3D real-time visualization of the ablation catheter and the circular mapping catheter placed in the pulmonary veins represents a major advantage of the Navx system.

Original languageEnglish (US)
Pages (from-to)285-296
Number of pages12
JournalClinical Research in Cardiology
Volume98
Issue number5
DOIs
StatePublished - May 1 2009

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Catheter Ablation
Atrial Fibrillation
Pulmonary Veins
Atrial Appendage
Anatomy
Spiral Computed Tomography
Cardiac Arrhythmias
Catheters
Recurrence
Heart Atria
Electric Impedance

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • MRI
  • Multi-detector spiral computed tomography
  • Pulmonary veins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach. / Kettering, Klaus; Greil, Gerald F.; Fenchel, Michael; Kramer, Ulrich; Weig, Hans Joerg; Busch, Mathias; Miller, Stephan; Sieverding, Ludger; Laszlo, Roman; Schreieck, Juergen.

In: Clinical Research in Cardiology, Vol. 98, No. 5, 01.05.2009, p. 285-296.

Research output: Contribution to journalArticle

Kettering, K, Greil, GF, Fenchel, M, Kramer, U, Weig, HJ, Busch, M, Miller, S, Sieverding, L, Laszlo, R & Schreieck, J 2009, 'Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach', Clinical Research in Cardiology, vol. 98, no. 5, pp. 285-296. https://doi.org/10.1007/s00392-009-0001-9
Kettering, Klaus ; Greil, Gerald F. ; Fenchel, Michael ; Kramer, Ulrich ; Weig, Hans Joerg ; Busch, Mathias ; Miller, Stephan ; Sieverding, Ludger ; Laszlo, Roman ; Schreieck, Juergen. / Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach. In: Clinical Research in Cardiology. 2009 ; Vol. 98, No. 5. pp. 285-296.
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T1 - Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach

AU - Kettering, Klaus

AU - Greil, Gerald F.

AU - Fenchel, Michael

AU - Kramer, Ulrich

AU - Weig, Hans Joerg

AU - Busch, Mathias

AU - Miller, Stephan

AU - Sieverding, Ludger

AU - Laszlo, Roman

AU - Schreieck, Juergen

PY - 2009/5/1

Y1 - 2009/5/1

N2 - Background: Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug refractory atrial fibrillation. However, catheter ablation of atrial fibrillation is still a challenge. This is partially due to the high degree of variability with regard to the individual anatomy. Nevertheless, 3D imaging systems (CT, MRI) provide detailed information about the individual left atrial and pulmonary vein morphology. A 3D CT or MRI reconstruction of the left atrium can be displayed in the Navx-/Ensite-system in a synchronised way during the ablation procedure, thereby facilitating the intervention. This study summarizes our preliminary experience with different strategies of AF ablation using the Navx-/Ensite-system and a CT-/MRI-guided approach. Methods: In a total of 41 patients, cardiac MRI (n = 7) or multi-detector spiral computed tomography (n = 34) was performed prior to an ablation procedure. Catheter ablation was performed for paroxysmal atrial fibrillation in 31 patients and for persistent atrial fibrillation in 10 patients. A 3D MRI or high resolution spiral CT data acquisition was performed and a surface rendered model of the LA was created. This model was displayed in the Navx-/Ensite-system throughout the ablation procedure. Results: Catheter ablation was performed using the Navx-system (n = 38) or the Ensite-system (n = 3). Three strategies were used depending on the type of atrial fibrillation: segmental isolation of the pulmonary veins (facilitated by a 3D real-time visualization of the ablation catheter and a circumferential mapping catheter; group A: 20 patients), linear lesions (group C: 3 patients) and a combined approach (group B; 18 patients). The CT-/MRI-models provided an excellent overview over the pulmonary veins and the left atrial appendage. They revealed a high degree of variability with regard to the individual anatomy (e.g. dimensions of the left atrial appendage, pulmonary vein ostia). The CT scans provided a more detailed reconstruction of the left atrial anatomy than the MRI scans (especially in patients who were in atrial fibrillation at the time of the data acquisition). In some patients, the CT-/MRI-models revealed a very small diameter of some pulmonary veins or side branches close to the ostium (e.g. right inferior pulmonary vein). Therefore, no attempt was made to achieve complete pulmonary vein isolation in some patients. In group A, 16/20 (80%) patients had no arrhythmia recurrence [mean follow-up 359 days (SD ± 317 days)]. Twelve out of eighteen (67%) patients in group B [mean follow-up 452 days (SD ± 311 days)] and 2/3 (67%) patients in group C did not experience an arrhythmia recurrence [mean follow-up 1,000 days (SD ± 34 days)]. There were no major complications. Conclusions: The information derived from 3D CT- or MRI-reconstructions facilitates AF ablations performed with the Navx-/Ensite-mapping system and enhances the safety of these procedures. Furthermore, the availability of an additional impedance-based 3D real-time visualization of the ablation catheter and the circular mapping catheter placed in the pulmonary veins represents a major advantage of the Navx system.

AB - Background: Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug refractory atrial fibrillation. However, catheter ablation of atrial fibrillation is still a challenge. This is partially due to the high degree of variability with regard to the individual anatomy. Nevertheless, 3D imaging systems (CT, MRI) provide detailed information about the individual left atrial and pulmonary vein morphology. A 3D CT or MRI reconstruction of the left atrium can be displayed in the Navx-/Ensite-system in a synchronised way during the ablation procedure, thereby facilitating the intervention. This study summarizes our preliminary experience with different strategies of AF ablation using the Navx-/Ensite-system and a CT-/MRI-guided approach. Methods: In a total of 41 patients, cardiac MRI (n = 7) or multi-detector spiral computed tomography (n = 34) was performed prior to an ablation procedure. Catheter ablation was performed for paroxysmal atrial fibrillation in 31 patients and for persistent atrial fibrillation in 10 patients. A 3D MRI or high resolution spiral CT data acquisition was performed and a surface rendered model of the LA was created. This model was displayed in the Navx-/Ensite-system throughout the ablation procedure. Results: Catheter ablation was performed using the Navx-system (n = 38) or the Ensite-system (n = 3). Three strategies were used depending on the type of atrial fibrillation: segmental isolation of the pulmonary veins (facilitated by a 3D real-time visualization of the ablation catheter and a circumferential mapping catheter; group A: 20 patients), linear lesions (group C: 3 patients) and a combined approach (group B; 18 patients). The CT-/MRI-models provided an excellent overview over the pulmonary veins and the left atrial appendage. They revealed a high degree of variability with regard to the individual anatomy (e.g. dimensions of the left atrial appendage, pulmonary vein ostia). The CT scans provided a more detailed reconstruction of the left atrial anatomy than the MRI scans (especially in patients who were in atrial fibrillation at the time of the data acquisition). In some patients, the CT-/MRI-models revealed a very small diameter of some pulmonary veins or side branches close to the ostium (e.g. right inferior pulmonary vein). Therefore, no attempt was made to achieve complete pulmonary vein isolation in some patients. In group A, 16/20 (80%) patients had no arrhythmia recurrence [mean follow-up 359 days (SD ± 317 days)]. Twelve out of eighteen (67%) patients in group B [mean follow-up 452 days (SD ± 311 days)] and 2/3 (67%) patients in group C did not experience an arrhythmia recurrence [mean follow-up 1,000 days (SD ± 34 days)]. There were no major complications. Conclusions: The information derived from 3D CT- or MRI-reconstructions facilitates AF ablations performed with the Navx-/Ensite-mapping system and enhances the safety of these procedures. Furthermore, the availability of an additional impedance-based 3D real-time visualization of the ablation catheter and the circular mapping catheter placed in the pulmonary veins represents a major advantage of the Navx system.

KW - Atrial fibrillation

KW - Catheter ablation

KW - MRI

KW - Multi-detector spiral computed tomography

KW - Pulmonary veins

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