3-D Image integration: back to real anatomy (1) Best landmark registration could be achieved at posterior LA-PV junctions
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
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
3-D Image integration: back to real life (2) The effect of cardiac rhythm: Patel et al, JICE 2008
3-D Image integration: back to real life (3) The effect of cardiac rhythm: Patel et al, JICE 2008
3-D Image integration: back to real life (2) The effect of cardiac cycle: Sra el et al, JICE 2008
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 %
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.
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