A randomised comparison of Cartomerge vs. NavX fusion in the catheter ablation of atrial fibrillation: The CAVERN Trial

Published on Mar 1, 2012in Journal of Interventional Cardiac Electrophysiology1.9
路 DOI :10.1007/S10840-011-9632-7
Kim Rajappan18
Estimated H-index: 18
(St Bartholomew's Hospital)
Sources
Abstract
Purpose Integration of a 3D reconstruction of the left atrium into cardiac mapping systems can aid catheter ablation of atrial fibrillation (AF). The two most widely used systems are NavX Fusion and Cartomerge. We aimed to compare the clinical efficacy of these systems in a randomised trial.
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References16
Newest
Purpose Pulmonary vein antrum isolation (PVAI) guided by intracardiac echocardiography and a roaming circular mapping catheter is an effective treatment modality for atrial fibrillation. Unfortunately, the complexity of this technique leads to long procedure times and high fluoroscopy exposure. This study examined the effect of two different mapping systems on the procedural characteristics and clinical outcomes of PVAI for atrial fibrillation.
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#1Ross J. Hunter (St Bartholomew's Hospital)H-Index: 25
#2M Ginks (St Bartholomew's Hospital)H-Index: 11
Last. Richard J. Schilling (St Bartholomew's Hospital)H-Index: 57
view all 12 authors...
Aims To investigate the impact of variant pulmonary vein (PV) anatomy and the use of three-dimensional image integration (3D-II) on long-term efficacy of catheter ablation for atrial fibrillation (AF). Methods Consecutive procedures from 2002 to 2007 were analysed from a prospective database. All patients underwent wide area circumferential ablation, with linear lesions added and complex fractionated electrograms targeted for persistent AF. Imaging was segmented on Carto to assess PV anatomy. Re...
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#1Emanuele BertagliaH-Index: 25
#2Paolo Della BellaH-Index: 29
Last. Franco ZoppoH-Index: 17
view all 14 authors...
Aims The aim of this study was to investigate whether circumferential pulmonary vein (PV) isolation guided by image integration improves the procedural and clinical outcomes of atrial fibrillation (AF) ablation in comparison with segmental PV isolation and circumferential PV isolation guided by three-dimensional (3D) electroanatomical mapping alone. Methods and results Procedural and clinical outcomes of 573 patients who underwent their first catheter ablation for paroxysmal AF between January 2...
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#1Brian D. Powell (Mayo Clinic)H-Index: 19
#2Douglas L. Packer (Mayo Clinic)H-Index: 75
Over the years, various imaging modalities have been used to guide ablation procedures. Technology has rapidly progressed from Two-dimensional fluoroscopic imaging to several different forms of 3D mapping systems using magnetic and impedance sensors, as well as automated imaging components derived from computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and rotational angiography. These have provided greater anatomic detail for accurate ablation. However, ablation outcomes re...
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#1F.E.S.C. Paolo Della Bella M.D. (University of Milan)H-Index: 1
#2Gaetano Fassini (University of Milan)H-Index: 3
Last. Gianluca Pontone (University of Milan)H-Index: 1
view all 14 authors...
Image Integration for Catheter Ablation of Atrial Fibrillation. Background: Several studies have provided details of left atrial anatomy by means of the image integration techniques, particularly focusing on the atypical patterns of the pulmonary veins. Objective: To compare, in a prospective, randomized fashion, the conventional method of pulmonary vein disconnection and the image integration-guided approach. Methods: Two hundred and ninety consecutive patients (290 patients, mean age 55 卤 11 y...
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#2Kim Rajappan (St Bartholomew's Hospital)H-Index: 18
Aims A detailed appreciation of the left atrial/pulmonary venous (LA/PV) anatomy may be important in improving the safety and success of catheter ablation for AF. The aim of this randomized study was to determine the impact of computed tomographic (CT) integration into an electroanatomic mapping (EAM) system on clinical outcome in patients undergoing catheter ablation for atrial fibrillation (AF). Methods and results Eighty patients with AF were randomized to undergo first-time wide encirclement...
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Introduction: The complex anatomy of the left atrium (LA) makes location of ablation catheters difficult using fluoroscopy alone, and therefore 3D mapping systems are now routinely used. We describe the integration of a CT image into the EnSite NavX System with Fusion and its validation in patients undergoing atrial fibrillation (AF) or left atrial tachycardia (AT) catheter ablation. Methods and Results: Twenty-three patients (61 卤 9.2 years, 16 male) with paroxysmal (14) and persistent (8) AF a...
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#1Anthony G. Brooks (Royal Adelaide Hospital)H-Index: 32
#2Lauren Wilson (Royal Adelaide Hospital)H-Index: 11
Last. Prashanthan Sanders (Royal Adelaide Hospital)H-Index: 104
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Background Three-dimensional virtual anatomic navigation is increasingly used during mapping and ablation of complex arrhythmias. NavX Fusion software aims to mold the virtual anatomy to the patient's computed tomography (CT) image; however, the accuracy and clinical usefulness of this system have not been reported. Objective The purpose of this study was to assess the accuracy and describe the initial experience of CT image integration using NavX Fusion for atrial fibrillation ablation. Methods...
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Background: The alignment of three-dimensional (3D) left atrial images acquired by magnetic resonance (MR) with the anatomical information yielded by 3D mapping systems is one of the most critical issues in image integration techniques for catheter ablation of atrial fibrillation (AF). We assessed the accuracy of a simplified method of superimposing 3D MR left atrial images on real-time left atrial electroanatomic maps (registration). Methods: MR data on the left atrium in 40 patients with drug-...
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#1Jun Dong (Medical University of Graz)H-Index: 25
#2Darshan Dalal (Medical University of Graz)H-Index: 45
Last. Ronald D. Berger (Medical University of Graz)H-Index: 39
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Introduction:鈥俁egistration accuracy is of crucial importance to the successful use of image integration technique to facilitate atrial fibrillation (AF) ablation. It is well known that a patient's heart rhythm can switch from sinus rhythm (SR) to AF or vice versa during an AF ablation procedure. However, the impact of the heart rhythm change on the accuracy of left atrium (LA) registration has not been studied. Methods: This study included 10 patients who underwent AF ablation. Prior to the abla...
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#1Caroline H Roney ('KCL': King's College London)H-Index: 16
#2Charles Sillett ('KCL': King's College London)
Last. Steven A. Niederer ('KCL': King's College London)H-Index: 1
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Atrial arrhythmias, including atrial fibrillation and atrial flutter, may be treated through catheter ablation. The process of atrial arrhythmia catheter ablation, which includes patient selection, pre-procedural planning, intra-procedural guidance, and post-procedural assessment, is typically characterized by the use of several imaging modalities to sequentially inform key clinical decisions. Increasingly, advanced imaging modalities are processed via specialized image analysis techniques and c...
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#1Yuan ZhongH-Index: 1
#2Jingying Zhang (Tongji University)H-Index: 3
Last. Yawei XuH-Index: 27
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Background Musclin is involved in the regulation of natriuretic peptide (NP) clearance and may affect the concentration of atrial natriuretic peptide (ANP). It has also been found to play an important role in several diseases, such as diabetes mellitus and hypertension. Both abnormalities in ANP and associated medical history are involved in the pathogenesis of atrial fibrillation (AF). However, plasma concentration of musclin as a biomarker for risk stratification in patients with AF has not be...
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#1Ina Vernikouskaya (University of Ulm)H-Index: 7
#2Dagmar Bertsche (University of Ulm)H-Index: 1
Last. Volker Rasche (University of Ulm)H-Index: 33
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PURPOSE With the growing availability and variety of imaging modalities, new methods of intraoperative support have become available for all kinds of interventions. The basic principles of image fusion and image guidance have been widely adopted and are commercialized through a number of platforms. Although multimodal systems have been found to be useful for guiding interventional procedures, they all have their limitations. The integration of more advanced guidance techniques into the product f...
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#1Enkang Liu (SJTU: Shanghai Jiao Tong University)
#2Yixin Ma (SJTU: Shanghai Jiao Tong University)
Last. Hao Ge (SJTU: Shanghai Jiao Tong University)H-Index: 2
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Atrial fibrillation (AF) is a kind of high-prevalence arrhythmia for which catheter radiofrequency ablation has been approved an effective surgical treatment method. The positioning accuracy of the catheter and the real-time measurement of intracardiac physiological parameters are critical for the management of surgery quality. In recent years, the 3D mapping via magnetic field measurement has been successfully implemented to serve the above purpose but still, it is necessary to further improve ...
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#1Yuan Zhong (Tongji University)H-Index: 1
#2Kai Tang (Tongji University)H-Index: 11
Last. Yawei Xu (Tongji University)H-Index: 27
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BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia with serious complications and a high rate of recurrence after catheter ablation. Recently, mutation ofMYL4was reported as responsible for familial atrial cardiomyopathy and AF. This study aimed to determine the association between polymorphism inMYL4with the onset and recurrence of AF.Methods鈥刟nd鈥凴esults:A total of 7 single-nucleotide polymorphisms were selected by linkage disequilibrium and genotyped in 510 consecutive AF patie...
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view all 5 authors...
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#1Lixia Shu (Capital Medical University)H-Index: 1
#2Jin Wang (Capital Medical University)H-Index: 1
Last. Changyan Lin (Capital Medical University)H-Index: 1
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Background Electro-anatomical maps (EAM) and CT surface registration are widely used for catheter navigation in atrial fibrillation ablations. However, few studies have investigated the registration algorithm. Moreover, some of them are semiautomatic, so that physicians must be proficient; some are inaccurate for catheter navigation. A both automatic and accurate registration method is needed. Method A Hausdorff distance based approach (HD) was proposed for EAM/CT registration. First, using prin...
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#1Lixia Shu (Capital Medical University)
#2Jin Wang (Capital Medical University)
Catheter navigation guided by the registration of electroanatomic map (EAM) and CT surface is widely used in atrial fibrillation (AF) ablations, however, few studies have done on the registration algorithm. Moreover, some of them are semiautomatic that physicians must be professional; some are inaccurate for catheter navigation. A both automatic and accurate registration method is needed. Therefore, in this study, we proposed a traditional iterative closest point (ICP) based approach for EAM and...
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#1David L Dunkerley (UW: University of Wisconsin-Madison)H-Index: 29
#2Jordan M. Slagowski (UW: University of Wisconsin-Madison)H-Index: 3
Last. Michael A. Speidel (UW: University of Wisconsin-Madison)H-Index: 11
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Scanning-beam digital x-ray (SBDX) is an inverse geometry x-ray fluoroscopy system capable of tomosynthesis-based 3-D catheter tracking. This work proposes a method of dose-reduced 3-D catheter tracking using dynamic electronic collimation (DEC) of the SBDX scanning x-ray tube. This is achieved through the selective deactivation of focal spot positions not needed for the catheter tracking task. The technique was retrospectively evaluated with SBDX detector data recorded during a phantom study. D...
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#1Caspar Gruijthuijsen (Katholieke Universiteit Leuven)H-Index: 9
#2Benoit Rosa (Katholieke Universiteit Leuven)H-Index: 10
Last. Dominiek Reynaerts (Katholieke Universiteit Leuven)H-Index: 37
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Catheter navigation is typically based on fluoroscopy. This implies exposure to harmful radiation, lack of depth perception and limited soft-tissue contrast. Catheter navigation would benefit from guidance that makes better use of detailed pre-operatively acquired MR/CT images, while reducing radiation exposure and improving spatial awareness of the catheter pose and shape. A prerequisite for such guidance is an accurate registration between the catheter tracking system and the MR/CT scans. Exis...
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