Reconstructing and Registering Three-Dimensional Rotational Angiogram of Left Atrium during Ablation of Atrial Fibrillation

Background: Three-dimensional (3D) image of left atrium (LA) can greatly facilitate ablation of atrial fibrillation (AF). Reconstructing method using computed tomography (CT) has certain limitations. The 3D image of LA can be intraprocedurally reconstructed by a rotational angiography technique. Methods: Forty-six patients undergoing AF ablation were included in this study. Preprocedural CT imaging and intraprocedural reconstructing 3D rotational angiogram (3DRA) of LA were performed in all the patients. Rapid ventricular pacing (RVP, 300 ms) was used to inhibit the drainage of atrium. During RVP, contrast medium was injected into the LA, and rotational angiography was performed. The 3DRA was reconstructed and was registered with the live fluoroscopy. The 3DRA was evaluated in comparison to the CT image. In the navigation of the registered 3DRA, the ablation of AF was performed. Results: Forty-four 3DRAs (95.7%) were successfully reconstructed and registered with the live fluoroscopy. The LA anatomy was delineated in the 3DRA in comparison to a CT image. AF ablation was successfully performed in the 44 patients in the navigation of the registered 3DRA. There were good correlations in the PV ostial diameter and the LA volume as assessed by 3DRA in comparison to a CT image (r >= 0.87). The radiation exposure in rotational angiography was substantially less than that in CT scanning (2.7 +/- 0.9 mSv vs. 24.9 +/- 3.1 mSv, P < 0.001). Conclusions: It is feasible to reconstruct and register the 3DRA with live fluoroscopy using the RVP method during the ablation of AF. (PACE 2009; 32: 1407-1416)