Role of three-dimensional imaging integration in atrial fibrillation ablation

Table 1 Anatomic variants of the pulmonary veins in 147 consecutive patients with atrial fibrillation undergoing a 64-slice computed tomography scan the day before the ablation procedure

Anatomy	n (%)
Four distinct PV oses	81 (55)
Common os	66 (45)
Left PVs	55
Right PVs	7
Left and right PVs	1
Inferior PVs	3
Adjunctive PVs	21 (14)
Right	16
Left	21
Roof	4

¹1 patient showed an adjunctive pulmonary vein both right and left. PV: Pulmonary vein.

Table 2 Overview of the studies designed to evaluate the methods and accuracy of imaging integration of the left atrium/pulmonary veins in an electroanatomic mapping system during the atrial fibrillation ablation procedure

Author	No. of pts	Percentage of pts with parox. AF	System	3D-imaging (No. of pts)	ICE	Type of EA reconstruction: single/multi chamber	No. of EA points	Distance between EA and CT/MRI points (mm)
								Mean	Maximum	Minimum
Tops et al[18]	16	31	CartoMerge	64-slice CT	N	Single	224 ± 59	2.1 ± 0.2	2.8 ± 1.8	1.7 ± 1.2
Dong et al[19]	16	62	CartoMerge	MRI (8)/64-slice CT (8)	N	Single	24 ± 7	2.1 ± 0.5	2.7 ± 1.8	0.9 ± 0.8
Kistler et al[20]	30	40	CartoMerge	8-slice CT	N	Single	39 ± 8	2.3 ± 0.4	9.3 ± 2.4	0 ± 0
Martinek et al[21]	40	65	CartoMerge	16-slice CT	N	Single	63 ± 14	1.6 ± 1.2	N/A	N/A
Heist et al[22]	61	57	CartoMerge	MRI (50)/64-slice CT (11)	N	Multi (LA + Ao)	LA (49 ± 25)	1.9 ± 0.6	4.3 ± 3.4	1.2 ± 1.0
							Ao (148 ± 41)
Fahmy et al[23]	124	55	CartoMerge	64-slice CT	N	N/A	59 ± 22	2.2 ± 1.7	N/A	N/A
Daccarett et al[24]	18	58	CartoMerge	64-slice CT	Y	Single	41 ± 8	5-101	N/A	N/A
Bertaglia et al[25]	40	55	CartoMerge	MRI	N	Single	37 ± 10	1.3 ± 1.0	N/A	N/A
Richmond et al[26]	23	61	NAVx Fusion	8-slice CT	N	Single	N/A	3.2 ± 0.9	6.1 ± 1.0	2.9 ± 0.7
Brooks et al[27]	55	53	NAVx Fusion	64-slice CT	N	Single	N/A	2.6 ± 2.2	6.6 ± 2.8	1.9 ± 0.4
Rossillo et al[28]	40	45	CartoMerge	Multislice CT	Y	Single	47 ± 9	1.4 ± 0.3	N/A	N/A
Nölker et al[29]	38	50	CartoMerge	Rotational angiography	N	Single	104 ± 59	2.2 ± 0.4	N/A	N/A
Ejima et al[30]	24	83	CartoMerge	64-slice CT	N	Single	88 ± 34	1.7 ± 0.5	6.1 ± 2.7	0.04 ± 0.03

¹Distance between an electroanatomic (EA) point and the same point localized by ICE. 3D: Three dimensional; AF: Atrial fibrillation; Ao: Aorta; CT: Computed tomography; ICE: Intra-cardiac echocardiography; LA: Left atrium; MRI: Magnetic resonance imaging; N: No; Y: Yes; N/A: Not available; Parox.: Paroxysmal; pts: Patients.

Table 3 Overview of the studies designed to evaluate the impact of imaging integration for atrial fibrillation ablation on the procedure and clinical outcomes

Author	No. of pts	Type of study	Imaging	Type of evaluation	FU	Effect of imaging integration
						Fluoroscopy time	Procedure duration	Complications	Clinical outcome
Kistler et al[31]	94	Non-randomized	CT	3D vs Merge	6 mo	↓	=	=	↑
Martinek et al[32]	100	Non-randomized	CT	XP vs Merge	6 mo	=	=	↓	↑
Kistler et al[33]	80	Randomized	CT	XP vs Merge	1 yr	=	=	=	=
Tang et al[34]	81	Randomized	CT	XP vs Merge	1 yr	↓	↓	=	=
Della Bella et al[35]	290	Randomized	CT	Conv vs Merge	> 1 yr	↑	↑	=	↑
Bertaglia et al[36]	573	Non-randomized	CT/MRI	Conv vs XP vs Merge	> 1 yr	=	↓	=	↑
Caponi et al[37]	299	Randomized	MRI	XP vs Merge	1 yr	↓	=	=	=

3D: Three-dimensional; Conv: Conventional; CT: Computed tomography; FU: Follow-up; Merge: CartoMerge; MRI: Magnetic resonance imaging; XP: Carto XP; ↑: Increased; ↓: Decreased; ═: No difference; pts: Patients.