Computed tomography-fluoroscopy overlay evaluation during catheter ablation of left atrial arrhythmia

Aims Proper visualization of left atrial (LA) and pulmonary vein (PV) anatomy is of crucial importance during atrial fibrillation (AF) ablation. This two-centre study evaluated a new automatic computed tomography (CT)-fluoroscopy overlay system (EP navigator®, Philips Medical Systems, Best, The Netherlands) and the accuracy of different registration methods. Methods and results Fifty-six consecutive patients (age: 56 ± 14) with symptomatic AF underwent contrast CT of the LA/PV prior to ablation. Three registration methods were evaluated and validated by comparison with LA angiography: (i) catheter registration: the placement of catheters in identifiable anatomical structures; (ii) heart contour: based on aligning the fluoroscopy heart contours and the 3D-rendered CT volume; and (iii) spine registration: based on automatically aligning the segmented CT spine on fluoroscopy. Computed tomography segmentation was achieved in all but one patient due to motion artefacts. The mean duration of segmentation was 10 min and average registration lasted 7 min. Catheter and heart contour registration were highly accurate (discrepancy of 1.3 ± 0.6 and 0.3 ± 0.5 mm, respectively) when compared with spine registration (17 ± 9 mm, P < 0.05). The EP navigator was helpful during trans-septal puncture, gave an internal view of the atria and allowed tracking of ablation lesions. Conclusion The EP navigator enabled accurate live integration of CT images and real-time fluoroscopy. Registration utilizing catheter placement or heart contours was stable and reliable.