Kaseno Kenichi, Hisazaki Kaori, Nakamura Kohki, Ikeda Etsuko, Hasegawa Kanae, Aoyama Daisetsu, Shiomi Yuichiro, Ikeda Hiroyuki, Morishita Tetsuji, Ishida Kentaro, Amaya Naoki, Uzui Hiroyasu, Tada Hiroshi
Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, yoshida-gun Fukui, 910-1193, Japan.
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma,, Japan.
J Interv Card Electrophysiol. 2018 Dec;53(3):301-308. doi: 10.1007/s10840-018-0368-5. Epub 2018 Apr 14.
Intracardiac echocardiographic (ICE) imaging might be useful for integrating three-dimensional computed tomographic (CT) images for left atrial (LA) catheter navigation during atrial fibrillation (AF) ablation. However, the optimal CT image integration method using ICE has not been established.
This study included 52 AF patients who underwent successful circumferential pulmonary vein isolation (CPVI). In all patients, CT image integration was performed after the CPVI with the following two methods: (1) using ICE images of the LA derived from the right atrium and right ventricular outflow tract (RA-merge) and (2) using ICE images of the LA directly derived from the LA added to the image for the RA-merge (LA-merge). The accuracy of these two methods was assessed by the distances between the integrated CT image and ICE image (ICE-to-CT distance), and between the CT image and actual ablated sites for the CPVI (CT-to-ABL distance).
The mean ICE-to-CT distance was comparable between the two methods (RA-merge = 1.6 ± 0.5 mm, LA-merge = 1.7 ± 0.4 mm; p = 0.33). However, the mean CT-to-ABL distance was shorter for the LA-merge (2.1 ± 0.6 mm) than RA-merge (2.5 ± 0.8 mm; p < 0.01). The LA, especially the left-sided PVs and LA roof, was more sharply delineated by direct LA imaging, and whereas the greatest CT-to-ABL distance was observed at the roof portion of the left superior PV (3.7 ± 2.8 mm) after the RA-merge, it improved to 2.6 ± 1.9 mm after the LA-merge (p < 0.01).
Additional ICE images of the LA directly acquired from the LA might lead to a greater accuracy of the CT image integration for the CVPI.
心内超声心动图（ICE）成像可能有助于在心房颤动（AF）消融过程中整合三维计算机断层扫描（CT）图像以进行左心房（LA）导管导航。然而，尚未确定使用ICE的最佳CT图像整合方法。
本研究纳入了52例成功进行环肺静脉隔离（CPVI）的AF患者。在所有患者中，CPVI后采用以下两种方法进行CT图像整合：（1）使用从右心房和右心室流出道获取的LA的ICE图像（RA融合）；（2）将直接从LA获取的LA的ICE图像添加到RA融合图像中（LA融合）。通过整合后的CT图像与ICE图像之间的距离（ICE到CT距离）以及CT图像与CPVI实际消融部位之间的距离（CT到ABL距离）评估这两种方法的准确性。
两种方法之间的平均ICE到CT距离相当（RA融合=1.6±0.5mm，LA融合=1.7±0.4mm；p=0.33）。然而，LA融合的平均CT到ABL距离（2.1±0.6mm）比RA融合（2.5±0.8mm）短（p<0.01）。直接LA成像能更清晰地勾勒出LA，尤其是左侧肺静脉和LA顶部，RA融合后左上肺静脉顶部的CT到ABL距离最大（3.7±2.8mm），而LA融合后该距离改善至2.6±1.9mm（p<0.01）。
直接从LA获取的额外LA的ICE图像可能会提高CPVI的CT图像整合准确性。
