Registration of 3D Rotational Angiogram of the Heart and Esophagus on the Fluoroscopic View

Abstract

Although catheter ablation has been demonstrated as the potentially curative treatment for atrial fibrillation, radiofrequency energy delivery of the posterior left atrium could result in the thermal injury to the esophagus. Thus, the anatomical relationship between the left atrium (LA) and esophagus is crucial for the prevention of the injury of the esophagus during LA ablation. The position of the esophagus can be identified by integration of three dimensional electroanatomical mapping system with the computed tomography (CT). The esophagus, however, may shift even during the ablation procedure. In addition, the integration of the CT image and 3-dimensional mapping system could be difficult or even inaccurate due to the difference of the body posture, heart rhythm and hydration state. On the other hand, the three-dimensional rotational atriography (3DATG) is performed during the procedure. Furthermore, the 3DATG with the direct injection of contrast medium into the LA can be performed without the postural change. In the present series, catheter ablation of AF was performed with a use of the 3DATG by the direct LA administration and simultaneous esophagography. We examined the usefulness and safety of the 3DATG to evaluate the anatomical relationship between the LA and esophagus through the AF ablation procedure.