Open Access

Introduction: When antiarrhythmic drug therapy has failed, different approaches of pulmonary vein isolation are considered a reasonable option in the treatment of atrial fibrillation. It will be performed predominantly by radiofrequency catheter ablation. As the individual anatomy of left atrium and the pulmonary veins differs considerably, accurate visualization of these structures is essential during catheter positioning. Using non-fluoroscopic electroanatomic mapping system with image integration, electroanatomic mapping can be combined with highly detailed anatomical MRT or CT information on complex left atrial structures. This may facilitate catheter navigation during ablation for atrial fibrillation. Methods: The CARTO XP electroanatomic system was used in a project during biomedical engineering study to practice image integration of anonymized real patients that underwent pulmonary vein isolation by CARTO XP and a MRT/CT procedure. Using the image integration software, MRT or CT images were imported into the CARTO XP system. The next process was segmentation of the acquired images. It involves dividing the images into different regions in order to select the structures of interest. In clinical routine, this segmentation has to be performed before catheter ablation. Then, the segmented images were aligned with the reconstructed electroanatomic maps. This consists of several steps, including selection of the left atrium, scaling of the reconstructed geometry, fusion of the structures using landmarks, and optimization of the integration by adjusting the reconstructed geometry of the left atrium. Results: In the 3 months lasting period of the project, image integration was trained in 13 patients undergoing catheter ablation for atrial fibrillation. Within this period, time consumption for the process decreased from about 90 minutes at the beginning to about 35 minutes at the end for one patient. Conclusion: Image integration into non-fluoroscopic electroanatomic map is a sophisticated tool in cardiac radiofrequency catheter ablation. Intensive training is necessary to control the procedure.