Imanli Hasan, Bhatty Shaun, Jeudy Jean, Ghzally Yousra, Ume Kiddy, Vunnam Rama, Itah Refael, Amit Mati, Duell John, See Vincent, Shorofsky Stephen, Dickfeld Timm M
Maryland Arrhythmia and Cardiology Imaging Group (MACIG).
Division of Cardiology, Department of Medicine.
Pacing Clin Electrophysiol. 2017 Nov;40(11):1206-1212. doi: 10.1111/pace.13189. Epub 2017 Oct 6.
Visualization of left atrial (LA) anatomy using image integration modules has been associated with decreased radiation exposure and improved procedural outcome when used for guidance of pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation. We evaluated the CARTOSEG™ CT Segmentation Module (Biosense Webster, Inc.) that offers a new CT-specific semiautomatic reconstruction of the atrial endocardium.
The CARTOSEG™ CT Segmentation Module software was assessed prospectively in 80 patients undergoing AF ablation. Using preprocedural contrast-enhanced computed tomography (CE-CT), cardiac chambers, coronary sinus (CS), and esophagus were semiautomatically segmented. Segmentation quality was assessed from 1 (poor) to 4 (excellent). The reconstructed structures were registered with the electroanatomic map (EAM). PVI was performed using the registered 3D images.
Semiautomatic reconstruction of the heart chambers was successfully performed in all 80 patients with AF. CE-CT DICOM file import, semiautomatic segmentation of cardiac chambers, esophagus, and CS was performed in 185 ± 105, 18 ± 5, 119 ± 47, and 69 ± 19 seconds, respectively. Average segmentation quality was 3.9 ± 0.2, 3.8 ± 0.3, and 3.8 ± 0.2 for LA, esophagus, and CS, respectively. Registration accuracy between the EAM and CE-CT-derived segmentation was 4.2 ± 0.9 mm. Complications consisted of one perforation (1%) which required pericardiocentesis, one increased pericardial effusion treated conservatively (1%), and one early termination of ablation due to thrombus formation on the ablation sheath without TIA/stroke (1%). All targeted PVs (n = 309) were successfully isolated.
The novel CT- CARTOSEG™ CT Segmentation Module enables a rapid and reliable semiautomatic 3D reconstruction of cardiac chambers and adjacent anatomy, which facilitates successful and safe PVI.
在心房颤动（AF）消融术中，使用图像整合模块可视化左心房（LA）解剖结构，在用于指导肺静脉隔离（PVI）时，与减少辐射暴露及改善手术结果相关。我们评估了CARTOSEG™ CT分割模块（Biosense Webster公司），该模块提供了一种针对CT的新型心房内膜半自动重建方法。
对80例接受AF消融术的患者进行前瞻性评估，使用CARTOSEG™ CT分割模块软件。利用术前对比增强计算机断层扫描（CE-CT），对心脏腔室、冠状窦（CS）和食管进行半自动分割。分割质量从1（差）到4（优）进行评估。将重建结构与电解剖图（EAM）进行配准。使用配准后的3D图像进行PVI。
所有80例AF患者均成功完成心脏腔室的半自动重建。CE-CT DICOM文件导入、心脏腔室、食管和CS的半自动分割分别用时185±105秒、18±5秒、119±47秒和69±19秒。LA、食管和CS的平均分割质量分别为3.9±0.2、3.8±0.3和3.8±0.2。EAM与CE-CT衍生分割之间的配准精度为4.2±0.9毫米。并发症包括1例穿孔（1%），需要进行心包穿刺；1例心包积液增加，保守治疗（1%）；1例因消融鞘上血栓形成导致消融提前终止，未发生短暂性脑缺血发作/中风（1%）。所有目标肺静脉（n = 309）均成功隔离。
新型CT-CARTOSEG™ CT分割模块能够快速、可靠地对心脏腔室及相邻解剖结构进行半自动3D重建，有助于成功、安全地进行PVI。
