The impact of respiration on left atrial and pulmonary venous anatomy: Implications for image-guided intervention
The impact of respiration on left atrial and pulmonary venous anatomy: Implications for image-guided intervention
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DOI：
10.1016/j.hrthm.2005.08.008
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发表时间：
2005-11-01
期刊：
影响因子：
5.5
通讯作者：
Reddy, VY
中科院分区：
文献类型：
--
作者：
Noseworthy, PA;Malchano, ZJ;Reddy, VY
背景使用预先获取的CT/MR三维图像的图像引导介入是用于心房颤动（AF）消融的新兴策略，但可能受限于其使用静态图像来描绘动态生理学。生物因素（如呼吸）对左心房-肺静脉（LA-PV）解剖结构的影响尚不清楚，但可能具有重要意义。常规CT/MR成像在吸气屏气期间执行，而电解剖标测（EAM）在“安静”呼吸期间近似于呼气屏气。本研究探讨了呼吸对左心房-肺静脉解剖结构的影响，以及呼吸对EAM与3D MR imaging.Methods的整合所引入的误差。对20例接受AF导管消融术的患者在呼气末（EXP）和吸气末（INSP）进行术前MRI血管造影。比较了LA-PVs的3D INSP和EXP表面重建。在选定的患者，EAM数据采集过程中的消融程序（n=7）与3D MRI datasets.Results定性评估的INSP和EXP的3D图像显示张开的肺静脉和减少肺静脉口径的右侧肺静脉在举行吸气。将这两个数据集对齐后，按区域计算的平均表面-表面距离范围为1.99 mm（右中PV）至3.79 mm（左上级PV）。EXP数据集（2.30 ± 0.73 mm）的EAM与MRI模型的配准优于INSP数据集（3.03 ± 0.57 mm; p=0.004）。结论LA-PV解剖结构随呼吸发生显著变化。在标准保持吸气期间采集的MR图像可能在图像引导介入期间的配准中引入不必要的错误。
BACKGROUND Image-guided intervention using pre-acquired CT/MR 3-dimensional images is an emerging strategy for atrial fibrillation (AF) ablation but may be limited by its use of static images to depict dynamic physiology. The effect of biologic factors such as respiration on the left atrial-pulmonary venous (LA-PV) anatomy is not well understood but is likely to have important implications. Conventional CT/MR imaging is performed during an inspiratory breath-hold, while electroanatomical mapping (EAM) during "quiet" breathing approximates an expiratory breath-hold. This study examined the effects of respiration on LA-PV anatomy and the error introduced by respiration on the integration of EAM with 3D MR imaging.METHODS Pre-procedural MRI angiography was performed at both end-expiration (EXP) and end -inspiration (INSP) in 20 patients undergoing AF catheter ablation. 3D INSP and EXP surface reconstructions of the LA-PVs were compared. In selected pts, EAM data acquired during the ablation procedure (n=7) were integrated with the 3D MRI datasets.RESULTS Qualitative assessment of the INSP and EXP 3D images revealed splaying of the PVs and reduction in PV caliber of the right-sided PVs during held inspiration. After aligning these two datasets, the average surface-to-surface distance calculated by region ranged from 1.99mm (right middle PV) to 3.79mm (left superior PV). Registration of the EAM to the MRI models was better for the EXP dataset (2.30 +/- 0.73mm) than the INSP dataset (3.03 +/- 0.57mm; p=0.004).CONCLUSION There are significant changes in LA-PV anatomy with respiration. MR images acquired during standard held inspiration may introduce unnecessary errors in registration during image-guided intervention.