Novel three-dimensional imaging approach for cryoballoon navigation and confirmation of pulmonary vein occlusion.
Novel three-dimensional imaging approach for cryoballoon navigation and confirmation of pulmonary vein occlusion.
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DOI：
10.1111/pace.13858
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发表时间：
2020-03
期刊：
影响因子：
--
通讯作者：
Narayan SM
中科院分区：
文献类型：
--
作者：
Kowalewski CAB;Rodrigo M;Brodt C;Haddad F;Wang PJ;Narayan SM
冷冻球囊贴靠对于心房颤动（AF）中持久的肺静脉隔离（PVI）至关重要，然而传统标测系统难以对球囊进行可视化，并且肺静脉造影可能会遗漏小的或不在平面内的渗漏。我们报道了一种新型成像系统，它能在心房解剖结构内对冷冻球囊进行实时三维导航，从而可能规避这些问题。
一种新型叠加引导系统（OGS）将已获取的分割后的心房心脏断层扫描（CT）与透视进行配准，使得在PVI过程中能够在断层左心房成像内对冷冻球囊进行实时可视化。在一个基于患者特异性3D打印的左心房进行的模型实验表明了确认肺静脉贴靠和渗漏的可行性。我们对17例患者在PVI过程中对68根肺静脉前瞻性地应用了OGS。在所有病例中冷冻球囊均成功重建，并且将其贴靠情况与同时进行的肺静脉造影进行了比较。OGS发现了9根静脉（8例）中未被造影检测到的渗漏，这使得能够重新定位，并确认了其余68根静脉的贴靠情况。OGS与造影的一致性为83.8%（卡方检验，P <.01）
我们报道了一种用于冷冻球囊导管实时成像的新系统，以确保在左心房断层扫描内肺静脉的贴靠。在为确认球囊贴靠或渗漏与其他成像方式提供高度一致性的同时，该系统还识别出了造影遗漏的渗漏。未来的研究应确定该工具是否能为冷冻球囊定位提供一个新的参考。
Cryoballoon apposition is crucial for durable pulmonary vein isolation (PVI) in atrial fibrillation, yet the balloon is difficult to visualize by conventional mapping systems, and pulmonary venography may miss small or out-of-plane leaks. We report a novel imaging system that offers real-time 3D navigation of the cryoballoon within atrial anatomy that may circumvent these issues. A novel overlay guidance system (OGS) registers already-acquired segmented atrial cardiac tomography (CT) with fluoroscopy, enabling real-time visualization of the cryoballoon within tomographic left atrial imaging during PVI. Phantom experiments in a patient-specific 3D printed left atrium showed feasibility for confirming PV apposition and leaks. We applied OGS prospectively to 68 PVs during PVI in 17 patients. The cryoballoon was successfully reconstructed in all cases, and its apposition was compared to concurrent PV venography. The OGS uncovered leaks undetected by venography in nine veins (eight cases), which enabled repositioning, confirming apposition in remaining 68 veins. Concordance of OGS to venography was 83.8% (χ2, P < .01) We report a new system for real-time imaging of cryoballoon catheters to ensure PV apposition within the tomography of the left atrium. While providing high concordance with other imaging modalities for confirming balloon apposition or leak, the system also identified leaks missed by venography. Future studies should determine if this tool can provide a new reference for cryoballoon positioning.
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影响因子：
5.4
作者：
Chun KRJ;Brugada J;Elvan A;Gellér L;Busch M;Barrera A;Schilling RJ;Reynolds MR;Hokanson RB;Holbrook R;Brown B;Schlüter M;Kuck KH;FIRE AND ICE Investigators
通讯作者：
FIRE AND ICE Investigators
影响因子：
39.3
作者：
Kuck KH;Fürnkranz A;Chun KR;Metzner A;Ouyang F;Schlüter M;Elvan A;Lim HW;Kueffer FJ;Arentz T;Albenque JP;Tondo C;Kühne M;Sticherling C;Brugada J;FIRE AND ICE Investigators
通讯作者：
FIRE AND ICE Investigators
影响因子：
6.1
作者：
Calkins, Hugh;Kuck, Karl Heinz;Vardas, Panos E.
通讯作者：
Vardas, Panos E.
影响因子：
5.5
作者：
Heeger, Christian-Hendrik;Tscholl, Verena;Metzner, Andreas
通讯作者：
Metzner, Andreas
影响因子：
8.4
作者：
Metzner, Andreas;Burchard, Andre;Wissner, Erik
通讯作者：
Wissner, Erik