Combined Cardiac and Respiratory Motion Compensation for Atrial Fibrillation Ablation Procedures

摘要

Catheter ablation of atrial fibrillation has become an ac-cepted treatment option if a patient no longer responds to or tolerates drug therapy. A main goal is the electrical isolation of the pulmonary veins attached to the left atrium. Catheter ablation may be performed under fluoroscopic image guidance. Due to the rather low soft-tissue con-trast of X-ray imaging, the heart is not visible in these images. To over-come this problem, overlay images from pre-operative 3-D volumetric data can be used to add anatomical detail. Unfortunately, this over-lay is compromised by respiratory and cardiac motion. In the past, two methods have been proposed to perform motion compensation. The first approach involves tracking of a circumferential mapping catheter placed at an ostium of a pulmonary vein. The second method relies on a mo-tion estimate obtained by localizing an electrode of the coronary sinus (CS) catheter. We propose a new motion compensation scheme which combines these two methods. The effectiveness of the proposed method is verified using 19 real clinical data sets. The motion in the fluoro-scopic images was estimated with an overall average error of 0.55 mm by tracking the circumferential mapping catheter. By applying an algo-rithm involving both the CS catheter and the circumferential mapping catheter, we were able to detect motion of the mapping catheter from one pulmonary vein to another with a false positive rate of 5.8%.