Yamada Shinya, Lo Li Wei, Lin Yenn Jiang, Chang Shih Lin, Chung Fa Po, Hu Yu Feng, Tuan Ta Chuan, Chao Tze Fan, Liao Jo Nan, Lin Chin Yu, Chen Shih Ann
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Korean Circ J. 2019 Jan;49(1):84-96. doi: 10.4070/kcj.2018.0195. Epub 2018 Aug 31.
The differences between electromagnetic-based mapping (EM) and impedance-based mapping (IM) in 3D anatomical reconstruction have not been fully clarified. We aimed to investigate the anatomical accuracy between EM (MediGuide™) and IM (EnSite Velocity™) systems.
We investigated 15 consecutive patients (10 males, mean age 58±9 years) who underwent pulmonary veins (PVs) isolation for paroxysmal atrial fibrillation (PAF). Contrast-enhanced computed tomography (CT) image of the left atrium (LA) was acquired before ablation and the 3D geometry of the LA was constructed using EM during ablation procedure. We measured the 4 PV angles between the main trunk of each PV and the posterior LA after field scaling. Additionally, the posterior LA surface area was measured. The variables were compared to those of CT-based geometry. A control group of 40 patients who underwent conventional PVs isolation using IM were also evaluated.
The actual and relative changes of EM and CT-based geometry in all PV angles and posterior LA were significantly smaller compared to those of IM and CT-based geometry. Intraclass correlation coefficient (ICC) between EM and CT-based geometry were 0.871 (right superior pulmonary vein [RSPV]), 0.887 (right inferior pulmonary vein [RIPV]), 0.853 (left superior pulmonary vein [LSPV]), 0.911 (left inferior pulmonary vein [LIPV]), and 0.833 (posterior LA). On the other hand, ICC between IM and CT-based geometry were 0.548 (RSPV), 0.639 (RIPV), 0.691 (LSPV), 0.706 (LIPV), and 0.568 (posterior LA).
Image integration with EM enables high accurate visualization of cardiac anatomy compared to IM in PAF ablation.
基于电磁的标测（EM）与基于阻抗的标测（IM）在三维解剖重建中的差异尚未完全阐明。我们旨在研究EM（MediGuide™）系统与IM（EnSite Velocity™）系统之间的解剖学准确性。
我们对15例连续接受阵发性心房颤动（PAF）肺静脉（PVs）隔离术的患者（10例男性，平均年龄58±9岁）进行了研究。在消融术前获取左心房（LA）的对比增强计算机断层扫描（CT）图像，并在消融过程中使用EM构建LA的三维几何结构。在进行场缩放后，我们测量了每条PV主干与LA后壁之间的4个PV角度。此外，还测量了LA后壁表面积。将这些变量与基于CT的几何结构的变量进行比较。还对40例接受使用IM进行传统PVs隔离术的患者组成的对照组进行了评估。
与IM和基于CT的几何结构相比，EM和基于CT的几何结构在所有PV角度和LA后壁的实际和相对变化均显著更小。EM和基于CT的几何结构之间的组内相关系数（ICC）分别为0.871（右上肺静脉[RSPV]）、0.887（右下肺静脉[RIPV]）、0.853（左上肺静脉[LSPV]）、0.911（左下肺静脉[LIPV]）和0.833（LA后壁）。另一方面，IM和基于CT的几何结构之间的ICC分别为0.548（RSPV）、0.639（RIPV）、0.691（LSPV）、0.706（LIPV）和0.568（LA后壁）。
在PAF消融中，与IM相比，EM进行图像整合能够实现心脏解剖结构的高精度可视化。
