Korean Circ J.  2019 Jan;49(1):84-96. 10.4070/kcj.2018.0195.

The Accuracy and Clinical Applicability of a Sensor Based Electromagnetic Non-fluoroscopic Catheter Tracking System

• Yamada S
• Lo LW
• Lin YJ
• Chang SL
• Chung FP
• Hu YF
• Tuan TC
• Chao TF
• Liao JN
• Lin CY
• Chen SA

• KMID: 2430751
• DOI: http://doi.org/10.4070/kcj.2018.0195

Abstract

BACKGROUND AND OBJECTIVES
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 (MediGuideâ„¢) and IM (EnSite Velocityâ„¢) systems.
METHODS
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.
RESULTS
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).
CONCLUSIONS
Image integration with EM enables high accurate visualization of cardiac anatomy compared to IM in PAF ablation.

Keyword

Atrial fibrillation; Atrial flutter; Anatomy; Cardiovascular imaging; Fluoroscopy

MeSH Terms

Atrial Fibrillation
Atrial Flutter
Catheters*
Fluoroscopy
Hand
Heart Atria
Humans
Magnets*
Male
Pulmonary Veins

Figure

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  Figure 1 The creation of 3D geometry of the LA using MediGuide™ system. Upper panel shows original LA geometry. After the creation of the original LA geometry, a field scaling algorithm is applied to the original geometry. Lower left panel shows the impedance field scaled geometry (M-IM-GEO). Lower middle panel shows the electromagnetic field scaled geometry (M-EM-GEO). Lower right panel shows the CT-based geometry. To evaluate the anatomical accuracy, pulmonary vein angles (①-④), posterior LA surface area (⑤) and anterior-posterior diameter of the LA (⑥) were measured in each geometry. 3D = 3-dimensional; CT = computed tomography; LA = left atrium; M-EM-GEO = MediGuide group, electromagnetic field-scaled geometry; M-IM-GEO = MediGuide group, impedance field-scaled geometry.

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  Figure 2 The creation of 3D geometry of the LA) using Ensite Velocity™ system. Upper panel shows original LA geometry. After the creation of the original LA geometry, a field scaling algorithm is applied to the original geometry. Lower left panel shows the impedance field scaled geometry (C-IM-GEO). Lower right panel shows the CT based geometry. 3D = 3-dimensional; C-IM-GEO = conventional group, the impedance field-scaled geometry; CT = computed tomography; LA = left atrium.

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  Figure 3 Comparison of procedure and fluoroscopy times between MediGuide and Conventional groups. (A) Comparison of pulmonary veins isolation between the 2 groups. Left panel: procedure time and right panel: fluoroscopy time. (B) Comparison of cavo-tricuspid isthmus ablation between the 2 groups. Left panel: procedure time and right panel: fluoroscopy time.

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  Figure 4 Kaplan-Meier analysis of arrhythmia recurrence after ablation (MediGuide group [n=15] vs. Conventional group [n=40]).

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