Anatomical accuracy of the KODEX‐EPD novel 3D mapping system of the left atrium during pulmonary vein isolation: A correlation with computer tomography imaging

Figures

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  Figure 1. An example of the measurement technique on the KODEX‐EPD posterior‐anterior and PANO images. The anatomy demonstrated a left common PV and an early branch of the RIPV. Upper panel: PV and appendage os length and width diameters measured at an approximately 90° angle, between the yellow dots. The red lines demonstrate the measurement of the RSPV. Lower panel: superior, inferior, right and left posterior wall lines were measured, connecting the most upper points of the superior veins ostia and the most lower points of the inferior veins ostia, demonstrated with the yellow dashed lines. PV, pulmonary vein; RSPV, right superior PV

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  Figure 2. An example of the measurement technique on the CT images of the same patient shown in Figure 1. Measurements were performed using a 3D image on the CARTO auto‐segmentation module. Anatomy demonstrated a LCPV and a separate right middle PV. Upper panel: RSPV length and width diameters measured at an approximately 90° angle. Middle and lower panel: Posterior wall line measurements are shown (white dashed lines), the measurement points were placed sequentially (white dots), while leaving the last point in the same location when measuring the next line, hence using the exact same points for all the lines. CT, computed tomography; LCPV, left common pulmonary vein; PV, pulmonary vein; RSPV, right superior PV

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  Figure 3. (A) Spearman correlation demonstrating a high correlation (r = .75) between CT and KODEX‐EPD measurements, p < .01. (B) Bland‐Altman plot method demonstrating the measurements assessed by the KODEX‐EPD system were slightly higher than those assessed by CT, with a mean difference of 3.5 mm, p < .01. CT, computed tomography

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  Figure 4. An example of disagreement regarding a right middle pulmonary vein anatomy. The CT demonstrated a superior branch to the right inferior PV while the KODEX‐EPD system demonstrated a separate right middle pulmonary vein os. In addition, the pre‐CRYO and post‐CRYO anatomical map differed. The pre‐CRYO map demonstrated a separate RMPV while the post‐CRYO map demonstrated an early superior branch of the RIPV. CT, computed tomography; PV, pulmonary vein; RIPV, right inferior PV