Intraprocedural reconstruction of the left atrium and pulmonary veins as a single navigation tool for ablation of atrial fibrillation: A feasibility, efficacy, and safety study

BACKGROUND Pulmonary vein (PV) isolation is a technically challenging intervention. For this reason, integration of three-dimensional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) in order to enhance effectiveness and safety has been widely adopted. A novel imaging approach-intraprocedural rotational angiography and reconstruction of the left atrium and PVs-is feasible and provides high anatomic accuracy. OBJECTIVE The purpose of this study was to prove the feasibility, safety, and efficacy of this imaging approach as a single navigation tool for PV isolation. METHODS Forty-four patients (25 men and 19 women; age 57 +/- 11 years) with atrial. fibrillation (AF) who presented for PV isolation were studied. Rotational angiography during adenosine-induced ventricular asystole was performed under sedation with propofol. The left atrium and PVs were reconstructed by three-dimensional atriography using specialized software (EP navigator prototype, Philips Medical Systems). Three-dimensional atriography was used as a single navigation tool. for guiding PV isolation. RESULTS Of 176 PVs, 174 (99%) were isolated. Total procedural and fluoroscopy times were 192 +/- 46 minutes and 44 +/- 12 minutes, respectively. During follow-up of 6 +/- 3 months, 31 (70%) patients were free of symptoms and had no evidence of AF without any antiarrhythmic medication. MRI examination of 41 patients at 3-month follow-up excluded PV stenosis. No major complications occurred. CONCLUSION Three-dimensional atriography is a novel intraprocedural three-dimensional imaging technique that is based on rotational angiography. It can be safely and effectively used as a single navigation tool for performing PV isolation.