Presentation is loading. Please wait.

Presentation is loading. Please wait.

Integration of Imaging: Impact on Outcome of AF Ablation Ahmed Abdelaal, MD CHU Nancy, France CAIROSTIM NOV 2008.

Similar presentations


Presentation on theme: "Integration of Imaging: Impact on Outcome of AF Ablation Ahmed Abdelaal, MD CHU Nancy, France CAIROSTIM NOV 2008."— Presentation transcript:

1 Integration of Imaging: Impact on Outcome of AF Ablation Ahmed Abdelaal, MD CHU Nancy, France CAIROSTIM NOV 2008

2 Micro-reentrant atrial circuits Sueda T, Ann Thorac Surg 1997;63:1070-5 Pulmonary vein foci Haïssaguerre M, N Engl J Med 1998;339:659-66 Marshall ligament Hwang C, Circulation 2000;101:1503-5 Rotor Mandapati R, Circulation 2000;101:194- 99 Cardiac innervation Schauerte P, Circulation 2000;102:2274- 80 Coronary sinus Superior vena cava Right atrial foci... AF: from mechanisms to targets By courtesy- Christian de Chillou

3 Left atrium- PV anatomy LSPV - LAA junction Common vestibule for both LPV 4 PV > OR < 4 PV 77% 20% 23%

4 Left atrium- PV Imaging

5 ICE: 2/6 RPV (33%) -Venography overestimates PV ostial diamaters - TEE underestimates PV ostial diamaters -ICE is correlated to CT ostial diamaters

6 Image integration: from real to virtual anatomy

7 3-D Image integration: back to real anatomy

8 3-D Image integration: back to real anatomy

9 3-D Image integration: back to real anatomy (1) Best landmark registration could be achieved at posterior LA-PV junctions

10 3-D Image integration: back to real anatomy (2) Significant landmark shift after surface registration - Positively correlated to surface registration error - Surface registration errors were more evident for RPVs

11 3-D Image integration: back to real life (1) The effect of respiration: -Classic splaying effect of PV - Minimal at LA junction -Maximum at distal PV and MA area Ector et al, JCE 2008

12 3-D Image integration: back to real life (2) The effect of cardiac rhythm: Patel et al, JICE 2008

13 3-D Image integration: back to real life (3) The effect of cardiac rhythm: Patel et al, JICE 2008

14 3-D Image integration: back to real life (2) The effect of cardiac cycle: Sra el et al, JICE 2008

15 The need for 3-D image integration

16 10+/-5mm Superimposed+/-5mm

17 The need for 3-D image integration

18

19 The final impact of 3-D image integration on outcome of AF ablation Study No of pts XRT FOLLOW UP SUCCESS Kistler et al 2006 94 49 vs 62 25 weeks 78 vs 48 % Kai etal 2008 81 99 vs 29 6m 78 vs 74 % Kistler etal 2008 80 22 vs41 6m 56 vs 50 %

20 Conclusions 1. PV isolation is still the corner stone in the ablation of atrial fibrillation. 2. Different Cardiac imaging modalities are important for precise delineation of important LA anatomical structures crucial for safe and effective ablation. 3. The use of 3D image integration could be a useful tool taking into consideration its potential limitations during the mapping procedure.

21 Stanislas Square - Nancy


Download ppt "Integration of Imaging: Impact on Outcome of AF Ablation Ahmed Abdelaal, MD CHU Nancy, France CAIROSTIM NOV 2008."

Similar presentations


Ads by Google