Author + information
- Francesco F. Faletra, MD⁎ (, )
- François Regoli, MD, PhD,
- Gaetano Nucifora, MD and
- Angelo Auricchio, MD, PhD
- ↵⁎Address for correspondence:
Dr. Francesco F. Faletra, Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH 6900 Lugano, Switzerland
FLUOROSCOPY AND INTEGRATED 3-DIMENSIONAL (3D) ELECTRONATOMICAL MAPPING are currently the most used techniques to support catheter navigation within heart chambers. The real-time visualization of catheter movements within the heart can be easily provided by fluoroscopy; its use, however, carries potential significant biological risk and does not render precise visualization of catheter tip-heart wall contact. On the other hand, registration process of 3D cardiac computed tomography or cardiac magnetic resonance images on the electroanatomical map may carry some modest errors, but more importantly, it uses pre-acquired images (usually in late systole) limiting the reliability in establishing precise catheter tip-heart wall relationship over the entire cardiac cycle.
Real-time 3-dimensional transesophageal echocardiography (RT3DTEE) provides high-quality images of the posterior structures of the heart and their respective endocardial surface. Moreover, RT3DTEE may have enough temporal and spatial resolution to potentially track catheter movement into the heart, thus enabling real-time navigation of electrophysiological diagnostic and mapping catheters.
We present a collage of representative images obtained in 4 different radiofrequency catheter ablation (RFCA) procedures supported by RT3DTEE for navigation purposes including ablation of inferior isthmus in a patient with cavotricuspidal isthmus-dependent flutter (Fig. 1), isolation of pulmonary veins in a patient with paroxysmal atrial fibrillation (Figs. 2 and 3), ablation of left posteroseptal accessory pathway in a patient with symptomatic Wolff-Parkinson-White syndrome (Fig. 4), and finally, ablation of re-entry post-ischemic ventricular tachycardia in a patient with inferoposterior left ventricular aneurysm (Fig. 5).
The common thread of the presented cases is represented by the possibility to precisely navigate within both atria and posterior portions of the left ventricle by using high-quality, real-time 3D images generated by RT3DTEE in order to treat common arrhythmias. This new navigational approach may be particularly useful when long fluoroscopy time and dose is expected during complex RFCA or in obese patients, or in children in whom biological sensitivity to radiation is significantly higher than in older patients. However, prospectively conducted, eventually randomized trials evaluating procedural success, ablation time, and fluoroscopy time and dose need to be conducted to establish the real value of RT3DTEE in the setting of RFCA.
Dr. Auricchio is a consultant for Sorin Group, Medtronic, Biotronik, and Philips Medical Systems. He has received research grants from Sorin Group, Medtronic, Biotronik, and Boston Scientific. The other authors have reported that they have no relationships to disclose.
- American College of Cardiology Foundation