Mind the gap: Quantification of incomplete ablation patterns after pulmonary vein isolation using minimum path search
Mind the gap: Quantification of incomplete ablation patterns after pulmonary vein isolation using minimum path search
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DOI：
10.1016/j.media.2018.10.001
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发表时间：
2019-01-01
影响因子：
10.9
通讯作者：
Butakoff, Constantine
中科院分区：
文献类型：
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作者：
Nunez-Garcia, Marta;Camara, Oscar;Butakoff, Constantine
肺静脉隔离 (PVI) 是治疗心房颤动 (AF) 的常用方法，因为 AF 的初始触发因素通常源自肺静脉。成功的隔离会产生完全包围静脉的连续损伤（疤痕），从而阻止激活波传播到心房体。不幸的是，周围的病变通常是不完整的，成为疤痕和健康组织间隙的组合。这些间隙是 AF 复发的潜在原因，需要重新进行隔离程序。晚期钆增强心脏磁共振（LGE-CMR）是一种非侵入性方法，也可用于检测间隙，但目前这是一个耗时的过程，容易出现观察者间的高变异性。在本文中，我们提出了一种半自动识别和量化消融间隙的方法。间隙量化是通过图中的最小路径搜索来执行的，其中每个节点都是疤痕斑块，边缘是斑块之间的测地距离。我们提出相对间隙测量（RGM）来估计静脉周围间隙的百分比，其定义为总间隙长度与环绕静脉的路径总长度的比率。此外，还开发了 RGM 的高级版本，将不同疤痕分割技术的间隙量化估计集成到单个品质因数中。使用左心房的标准化分区进行基于人群的间隙分布统计和区域分析。我们根据 50 名接受射频消融 PVI 的 AF 患者的综合和临床数据评估了我们的方法。基于人群的分析得出结论，在处理的数据中，左上 PV 更容易出现病变间隙，而左下 PV 往往具有较小的间隙（两种情况下 p < .05）。此类信息对于 PVI 干预措施的优化和客观评估非常有用。 (C) 2018 Elsevier B.V. 保留所有权利。
Pulmonary vein isolation (PVI) is a common procedure for the treatment of atrial fibrillation (AF) since the initial trigger for AF frequently originates in the pulmonary veins. A successful isolation produces a continuous lesion (scar) completely encircling the veins that stops activation waves from propagating to the atrial body. Unfortunately, the encircling lesion is often incomplete, becoming a combination of scar and gaps of healthy tissue. These gaps are potential causes of AF recurrence, which requires a redo of the isolation procedure. Late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) is a non-invasive method that may also be used to detect gaps, but it is currently a time-consuming process, prone to high inter-observer variability. In this paper, we present a method to semi-automatically identify and quantify ablation gaps. Gap quantification is performed through minimum path search in a graph where every node is a scar patch and the edges are the geodesic distances between patches. We propose the Relative Gap Measure (RGM) to estimate the percentage of gap around a vein, which is defined as the ratio of the overall gap length and the total length of the path that encircles the vein. Additionally, an advanced version of the RGM has been developed to integrate gap quantification estimates from different scar segmentation techniques into a single figure-of-merit. Population-based statistical and regional analysis of gap distribution was performed using a standardised parcellation of the left atrium. We have evaluated our method on synthetic and clinical data from 50 AF patients who underwent PVI with radiofrequency ablation. The population-based analysis concluded that the left superior PV is more prone to lesion gaps while the left inferior PV tends to have less gaps (p < .05 in both cases), in the processed data. This type of information can be very useful for the optimization and objective assessment of PVI interventions. (C) 2018 Elsevier B.V. All rights reserved.