EP Lab Digest - December 2007 - (Page 20)

20 INSIDE THE EP LAB DECEMBER 2007 TECHNOLOGIES Continued from page 18 The CT data is visualized using a dedicated workstation (Extended Brilliance Workspace, Philips Medical Systems, Cleveland, Ohio).These reconstructions include thick-slab maximum intensity projection (MIP) reconstructions along the long axis of the V1 segments of the pulmonary veins and along the axial and coronal planes; 3D surface reconstructions of the posterior wall of the atrium with and without the esophagus and descending aorta; and CT venoscopy of the posterior wall of the left atrium and the ostia visualized from an intra-atrial perspective. In addition to the standard reconstructions, we also perform a single thick-slab MIP reconstruction along the long axis of the combined ostia on the left and right side of the atrium to measure the span of the combined ostial openings. further evaluation, including a small lung cancer, as well as a patient with clinically occult active tuberculosis. Lastly, patients can present with stenosis of the pulmonary veins as a late complication of radiofrequency ablation, and this finding is also easily assessed when comparing the pre- and delayed post-procedure CT scans. Electrophysiologists carefully evaluate pre-procedural images together with a radiologist on a routine basis and appreciate the input from the radiology department. Close collaboration between the departments of radiology and cardiology at our institution has made our CT pulmonary venography program highly successful. Philips Medical Systems offers the flexibility of realizing these emerging technologies. Figure 4. CT chamber segmentation. References 1. Integrated EP lab Using the same automated, whole heart segmentation, this time on the EP Navigator (Philips Medical Systems, Best, the Netherlands), we are able to segment and color code the heart structures, including segmentation of the left atrium and distal pulmonary veins. This modeling provides a link to the superimposition of the segmented model over the live fluoroscopy in the electrophysiology lab, which is one of the latest tools to facilitate catheter navigation during ablation procedures. This registration and overlay allows for much more accurate positioning of the catheters with a minimum of fluoroscopy and contrast administration and gives the operator a live 3D CT image of the left atrial anatomy superimposed on 2D fluoroscopy. Confirmation of the correct positioning of the ablation catheters can easily be performed using the overlaid segmented model. A variety of complications have been reported from radiofrequency ablation procedures.7–9 These include perforation into adjacent structures, such as the esophagus, pericardium, pleural space, embolic strokes, edema of the left atrium or pulmonary vein and, rarely, coronary occlusion. While many of these complications are immediate and are visible in the electrophysiology laboratory, these are also easily diagnosed using contrast-enhanced CT scanning. Because the radiologists review all of the pre-procedure CT scans, we have noted a variety of incidental but clinically significant patholog ies that required 2. 3. 4. 5. 6. 7. 8. 9. European Heart Rhythm Association; Heart Rhythm Society, Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006;48:854–906. Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of artial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659–666. Haissaguerre M, Shah DC, Jais P, et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000;102:2463–2465. Kato R, Lickfett L, Meininger, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation 2003;107:2004-2010. Hoffmeister PS, Chaudhry GM, Mendel J, et al. Evaluation of left atrial and posterior mediastinal anatomy by multidetector helical computed tomography imaging: relevance to ablation. J Interv Card Electrophysiol 2007;18:217–223. Pappone C, Oral H, Santinelli V, et al. Atrioesophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation 2004;109:2724–2726. Chen SA, Hsieh MH, Tai CT, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 1999;100:1879–1886. Haissaguerre M, Jais P, Shah DC, et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000;101:1408–1417. Yu WC, Hsu TL, Tai CT, et al. Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2001;12:887–892. Figure 5. PV view. Reprinted with permission from Cath Lab Digest 2007;10(15 Suppl):16–19. Readers, please also look for our Spotlight Interview on the lab at Caritas Saint Elizabeth’s Medical Center in an upcoming issue of EP Lab Digest! Figure 6. EP Navigator.

Table of Contents Feed for the Digital Edition of EP Lab Digest - December 2007

EP Lab Digest - December 2007 Improved Anatomical Orientation During AF Catheter Ablation: Experience from Leipzig Heart Center One EP Lab’s Solution to the Administration of Deep Sedation Contents Letter from the Editor Spotlight Interview: Northeast Georgia Medical Center Emerging Technologies for the Electrophysiology Lab The Western Atrial Fibrillation Symposium About the PRECEDE-HF Trial: Interview with William T. Abraham, MD, FACP, FACC, FAHA Overview on Shire and the Discontinuation of Ethmozine®: After the Heart Rhythm Society Intervenes, the Company Changes its Decision Minimizing the Risk of Infection at Children’s Sibley Heart Center: Interview with Nicole Jarrell, RNC, MSN, and J. Renee Watson, RN, CIC Is There a Link Between Gasoline Vapors and Brugada Syndrome? Interview with Darko Kranjcec, MD and Hugues Abriel, MD, PhD New Feature! Pacemaker/ICD Puzzle Email Discussion Group Events Calendar Industry News and Products

EP Lab Digest - December 2007

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