Multi-modal characterization of the left atrium by a fully automated integration of pre-procedural cardiac imaging and electro-anatomical mapping

Figures

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  Fig. 1. Alignment examples The top row shows anterior-poster (AP) and posterior-anterior (PA) views of alignment examples of one patient’s MRI (blue, left) and CT anatomy (right, red) with the corresponding EAM anatomy (green). The bottom row shows the regional residual Euclidean distances between the aligned anatomies (bottom). 1, Right superior PV; 2, Right inferior PV; 3, Left superior PV; 4, Left inferior PV; 5, Mitral valve anulus; MRI, magnetic resonance imaging; CT, computed tomography; EAM, electro-anatomical mapping. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

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  Fig. 2. Residual distances. Panel A shows the results for the alignment of MRI scans, panel B the alignment of CT scans. The distribution of the residual Euclidean distances is shown on the left with colors indicating individual patients. The percentage of left atrial surface with a residual distance less than 2.5 mm and 5 mm are shown on the right. MRI, magnetic resonance imaging; CT, computed tomography.

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  Fig. 3. CARTO resulted in a significant better alignment. CARTO anatomies exhibited significantly smaller median residual distances (1.5 [1.4–1.9] mm compared to 2.6 [1.9 – 3.1] mm for Ensite, p = 0.015), a larger area with distances less than 2.5 mm (74 [62 – 80]% for CARTO versus 50 [42 – 62]% for Ensite, p = 0.012), and a larger area with distances less than 5.0 mm (94 [86 – 99]% for CARTO versus 80 [71 – 90]% for Ensite, p = 0.019). This analysis was carried out using a Wilcoxon rank sum test.

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  Fig. 4. Example of a multi-modal re-do PVI roadmap. Alignment of different modalities allow for a multi-modal assessment of the left atrium and its relation to anatomical structures in its vicinity. In this example ‘scar’ was determined by low bipolar voltage in EAM and high signal intensity on LE-MRI. 1, Right superior PV; 2, Right inferior PV; 3, Left superior PV; 4, Left inferior PV; 5, Mitral valve anulus; AP view, anterior-posterior view; PA view, posterior-anterior view; CT, computed tomography; MRI, magnetic resonance imaging; LE, late gadolinium enhancement; EAM, electro-anatomical mapping.