Integration of cardiac magnetic resonance imaging with three-dimensional electroanatomic mapping to guide left ventricular catheter manipulation - Feasibility in a porcine model of healed myocardial infarction
Integration of cardiac magnetic resonance imaging with three-dimensional electroanatomic mapping to guide left ventricular catheter manipulation - Feasibility in a porcine model of healed myocardial infarction
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DOI：
10.1016/j.jacc.2004.08.063
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发表时间：
2004-12-07
影响因子：
24
通讯作者：
Ruskin, JN
中科院分区：
文献类型：
--
作者：
Reddy, VY;Malchano, ZJ;Ruskin, JN
目的：在一系列体外和体内实验中，我们评估了将三维（3D）磁共振成像（MRI）和电解剖成像（EAM）数据整合在一起指导实时左心室（LV）导管操作的可行性。背景：基于基质的导管消融治疗心肌梗死后室性心动过速需要对瘢痕心肌进行描绘，通常使用EAM系统。心脏MRI可以通过定位心肌疤痕来促进这一过程。方法采用定制程序将三维MRI数据集与实时EAM相结合。首先，使用LV的塑性模型来确定最优对齐/配准策略。为了确定体内定位过程的准确性，消融病灶被定向到正常猪lv内的医源性mri可见“目标”（氧化铁注射）（n = 5）。最后，在猪梗死模型（n = 6）中，通过靶向消融病变到疤痕边界来评估这种图像整合策略。结果体外实验表明，由于左室沿长轴旋转导致左室单独对准不准确。在注册过程中包含主动脉纠正了这个错误。在氧化铁注射实验中，消融病灶距离靶标1.8 +/- 0.5 mm。在猪梗死模型中，导管可以可靠地导航到初始瓣膜环，消融病灶均匀地位于瘢痕边界。结论：这些数据表明，预先获得的磁共振图像与实时测绘的配准足够准确，可以可靠且与临床相关地指导左室导管操作。(C) 2004年由美国心脏病学会基金会发布。
OBJECTIVES In a series of in vitro and in vivo experiments, we evaluated the feasibility of integrating three-dimensional (3D) magnetic resonance imaging (MRI) and electroanatomic mapping (EAM) data to guide real-time left ventricular (LV) catheter manipulation.BACKGROUND Substrate-based catheter ablation of post-myocardial infarction ventricular tachycardia requires delineation of the scarred myocardium, typically using an EAM system. Cardiac MRI might facilitate this procedure by localizing this myocardial scar.METHODS A custom program was employed to integrate 3D MRI datasets with real-time EAM. Initially, a plastic model of the LV was used to determine the optimal alignment/registration strategy. To determine the in vivo accuracy of the registration process, ablation lesions were directed at iatrogenic MRI-visible "targets" (iron oxide injections) within normal porcine LVs (n = 5). Finally, this image integration strategy was assessed in a porcine infarction model (n = 6) by targeting ablation lesions to the scar border.RESULTS The in vitro experiments revealed that registration of the LV alone results in inaccurate alignment due primarily to rotation along the chamber's long axis. Inclusion of the aorta in the registration process rectified this error. In the iron oxide injection experiments, the ablation lesions were 1.8 +/- 0.5 mm from the targets. In the porcine infarct model, the catheter could be reliably navigated to the initial valve annulus, and the ablation lesions were uniformly situated at the scar borders.CONCLUSIONS These data suggest that registration of pre-acquired magnetic resonance images with real-time mapping is sufficiently accurate to guide LV catheter manipulation in a reliable and clinically relevant manner. (C) 2004 by the American College of Cardiology Foundation.