Extra-Cavity Image Registration via the Aortic Root During Left Ventricular Mapping and Ablation

Area of Science:

• Cardiovascular Imaging
• Electrophysiology
• Medical Technology

Background:

• Computed tomography (CT) image integration for left ventricular (LV) ablation is limited by registration accuracy.
• Investigating a novel extra-cavity LV image registration method via the coronary cusp is crucial.

Purpose of the Study:

• To evaluate the accuracy and feasibility of extra-cavity LV image registration using CT via the coronary cusp.
• To compare this novel registration method with existing techniques in terms of accuracy and procedural outcomes.

Main Methods:

• Two patient groups (validation n=41, feasibility n=48) underwent extra-cavity registration via the aortic root.
• LV anatomy from CT was registered to real space, with accuracy verified by intracardiac echocardiography (ICE) and measurements of location and volume differences.
• Key metrics included LV volume, anatomical landmark differences, and procedural outcomes like success rates, complications, and procedure/fluoroscopic times.

Main Results:

• LV volume and location differences were comparable to ICE reconstructions in the validation group (e.g., <3.1 mm at LV summit).
• Feasibility group showed small average distance differences (e.g., 1.8 mm at LV summit).
• Procedure time was significantly reduced with CT image registration, while acute success, complication rates, and fluoroscopic times remained comparable to the validation group.

Conclusions:

• Extra-cavity registration via the coronary cusp enables accurate LV mapping and ablation.
• This method allows successful left ventricular (LV) ablation without requiring pre-procedural LV positioning.
• The technique offers a feasible and accurate alternative for LV ablation procedures.