Three-dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures.

Bourier, Felix; Vlachos, Konstantinos; Lam, Anna; Martin, Claire A; Takigawa, Masateru; Kitamura, Takeshi; Massoullié, Grégoire; Cheniti, Ghassen; Frontera, Antonio; Duchateau, Josselin; Pambrun, Thomas; Klotz, Nicolas; Derval, Nicolas; Denis, Arnaud; Hocini, Mélèze; Haïssaguerre, Michel; Cochet, Hubert; Jaïs, Pierre; Sacher, Frédéric

doi:10.1111/jce.14249

2019

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Document type:: Article; Early Access; Journal Article; Research Support, Non-U.S. Gov't
Author(s):: Bourier, Felix; Vlachos, Konstantinos; Lam, Anna; Martin, Claire A; Takigawa, Masateru; Kitamura, Takeshi; Massoullié, Grégoire; Cheniti, Ghassen; Frontera, Antonio; Duchateau, Josselin; Pambrun, Thomas; Klotz, Nicolas; Derval, Nicolas; Denis, Arnaud; Hocini, Mélèze; Haïssaguerre, Michel; Cochet, Hubert; Jaïs, Pierre; Sacher, Frédéric
Title:: Three-dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures.
Abstract:: BACKGROUND: We present a new, easily applicable approach for the guidance of cryoballoon (CB) pulmonary vein isolation (PVI) procedures that use the combination of a 3D-mapping system image integration module and computed tomographic (CT)-derived anatomy. The aim of this retrospective, nonrandomized study was to investigate: (a) an alternative use for an established radiofrequency image integration module for cryo procedures; (b) a guidance technology for cryo PVI based on integrated CT anatomy; and (c) its clinical impact. METHODS AND RESULTS: CT left atrium-angiography was performed in 50 consecutive patients before a CB PVI procedure, and a 3D reconstruction of the cardiac anatomy was segmented. A total of 25 patients were treated using conventional fluoroscopy; 25 patients were treated using the 3D image integration technique. In the image integration group, the CARTO3 UNIVU (Biosense Webster) module was used for image integration of 3D anatomy and fluoroscopic imaging. Transseptal puncture and cryo PVI were guided by 3D-overlay imaging. Procedures were feasible without complications in all patients and cryo PVI procedures were successfully guided using the image integration technique. The intraprocedural time needed to perform image integration was 37 ± 10 seconds. Fluoroscopy time was 31.7 ± 11.7 minutes in the conventional group and 20.1 ± 7.9 minutes in the image integration group (P < .001), procedure time was 116.3 ± 29.0 minutes in the conventional group vs 101.2 ± 20.9 minutes in the 3D group (P = .04). CONCLUSION: 3D-overlay guidance of CB PVI is feasible, safe, and applicable in real time with minimal effort. It may significantly reduce radiation exposure by introducing 3D information, known from electroanatomic mapping systems, into cryo PVI procedures.
Journal title abbreviation:: J Cardiovasc Electrophysiol
Year:: 2019
Journal volume:: 30
Journal issue:: 12
Pages contribution:: 2790-2796
Fulltext / DOI:: doi:10.1111/jce.14249
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31646698
Print-ISSN:: 1045-3873
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2019