Z Kardiol 94: Suppl 2 (2005)

Initial experience with catheter ablation of complex arrhythmias using the Ensite-/Navx-system and a MRI-/CT-guided approach

K. Kettering1, G. Greil2, M. Fenchel3, U. Kramer3, S. Miller3, L. Sieverding2, J. Schreieck4, S. Schroeder4, V. Kuehlkamp5, C. Mewis6

1Kardiologie, Medizinische Uniklinik III, Tübingen, BusinessLogic.Land; 2Kinderkardiologie, Universitätskinderklinik, Tübingen; 3Radiologische Diagnostik, Eberhard-Karls-Universität Tübingen, Tübingen; 4Medizinische Klinik und Poliklinik III / Kardiologie, Medizinische Universitätsklinik, Tübingen; 5Elektrophysiologie, Herzzentrum Bodensee, Konstanz; 6Innere Medizin II, Universitätsklinikum des Saarlandes, Homburg/Saar;

Catheter ablation of complex arrhythmias is still technically challenging despite of the use of three-dimensional mapping systems. These systems are limited to reconstruct the complete "true" anatomy by the reach of the mapping electrode related to the catheter properties. New 3-D imaging systems provide detailed information about the individual anatomy. A 3-D MRI or CT reconstruction of the region of interest can be displayed in the Ensite-/Navx-system in a synchronised way during the ablation procedure and might facilitate the intervention. In a total of 19 pts., MRI (n=11, 1.5 T, Philips Intera NT) or multi-detector spiral computed tomography (n=8; Sensation 16 and 64, Siemens) was performed prior to an ablation procedure. For the MRI, a steady state free precession (SSFP) sequence (TR 3.64 ms, TE 1.82 ms, FA 90 degree, resolution 1.0x1.1x1.1 mm³ - 1.1x1.29x1.29 mm³) with respiratory navigator gating, vector ECG triggering with arrhythmia rejection and T2-preparation pulse was used. Then, a surface rendered model of the cardiac chamber of interest was created. Catheter ablation was performed using the Ensite-system (n=8) or the Navx-system (n=11). Catheter ablation was performed for AF in 15 pts., for right atrial tachycardia in 2 pts. and for right ventricular tachycardia in 2 pts. The knowledge of the individual anatomy resulting from the MRI/CT model facilitated the ablation procedure in all cases. This proved to be valuable especially for AF ablations in which the knowledge of the individual anatomy of the pulmonary veins and the left atrial appendage is crucial. The information derived from MRI and CT scans facilitates ablations performed with the Ensite-/Navx mapping system. This is very important for left atrial procedures. In the future, image fusion between MRI/CT data and 3-D mapping systems might allow for true 3-D electrophysiologic mapping and might result in a better understanding of the underlying substrate of complex arrhythmias.

http://www.abstractserver.de/dgk2005/ht/abstracts/P357.htm