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Proceedings Paper

Pre-ablative high-resolution MRA facilitates electrophysiologic pulmonary vein ablation and reduces fluoroscopy time in patients with paroxysmal atrial fibrillation
Author(s): Jeremy D. Collins; F. Scott Pereles; David Bello; Timothy Betts; Anish Zachariah; Ryan Kaliney; Gina K. Song; Stephanie M. Shors; James C. Carr; John Paul Finn
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Paper Abstract

Pulmonary MRA generates high-resolution images of the pulmonary veins (PV) and left atrium (LA), permitting characterization of complex PV anatomy, which is useful in electrophysiologic PV catheter ablation, a proven technique for the treatment of paroxysmal atrial fibrillation (PAF). The purpose of this study was to determine if pre-ablative pulmonary MRA with intra-ablative viewing facilitates ablation by reducing fluoroscopy time. We studied the morphology of the LA and PV at 1.5T (Magnetom Sonata, Siemens Medical Solutions, Erlangen Germany) with breath-held gadolinium-enhanced 3D MRA in 7 patients with PAF undergoing PV ablation. Data was volume rendered (VR) on a stereoscopic workstation. PV ostial diameter and cross-sectional area measurements were obtained on multi-planar reformatted (MPR) images. VR datasets were converted into digital movies and were viewed on a laptop computer adjacent to real-time fluoroscopic images. Fluoroscopy times for patients undergoing pre-ablative MPA mapping were compared with a cohort of 22 consecutive patients diagnosed with PAF who underwent catheter ablation without pre-ablative MRA planning. Mean PV ablation fluoroscopic time with MRA planning versus fluoroscopic imaging alone were 84±20 minutes and 114±20 minutes respectively. Pre-ablative MRA planning resulted in a significant mean fluoroscopy time savings of 26% (p<0.05). In patients with PAF undergoing PV ablation, analysis of MRA datasets depicting PV anatomy confirms that there is great variability in anatomy between veins. Pre-ablative 3D PV mapping by MRA greatly facilitates fluoroscopic identification of individual veins and significantly reduces fluoroscopic radiation time.

Paper Details

Date Published: 22 May 2003
PDF: 3 pages
Proc. SPIE 5034, Medical Imaging 2003: Image Perception, Observer Performance, and Technology Assessment, (22 May 2003); doi: 10.1117/12.480098
Show Author Affiliations
Jeremy D. Collins, Feinberg School of Medicine/Northwestern Univ. (United States)
F. Scott Pereles, Feinberg School of Medicine/Northwestern Univ. (United States)
David Bello, Feinberg School of Medicine/Northwestern Univ. (United States)
Timothy Betts, Feinberg School of Medicine/Northwestern Univ. (United States)
Anish Zachariah, Feinberg School of Medicine/Northwestern Univ. (United States)
Ryan Kaliney, Feinberg School of Medicine/Northwestern Univ. (United States)
Gina K. Song, Feinberg School of Medicine/Northwestern Univ. (United States)
Stephanie M. Shors, Feinberg School of Medicine/Northwestern Univ. (United States)
James C. Carr, Feinberg School of Medicine/Northwestern Univ. (United States)
John Paul Finn, Univ. of California/Los Angeles (United States)


Published in SPIE Proceedings Vol. 5034:
Medical Imaging 2003: Image Perception, Observer Performance, and Technology Assessment
Dev P. Chakraborty; Elizabeth A. Krupinski, Editor(s)

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