DOI: https://doi.org/10.20535/RADAP.2018.72.47-52

Segmentation of anatomical heart structures in Ensite Verismo software for radiofrequency ablation of arrhythmogenic tissues

V. V. Filimonova, M. M. Sychyk, L. D. Tarasova, B. B. Kravchuk, B. V. Batsak, A. V. Pokanievych

Abstract


Review of the problem. The relevance of the research is the need of a high-quality imaging of the left atrium anatomy for the effectiveness of radiofraquency ablation of arrhythmogenic tissue of the myocardium in real time. For its safety it is important to assess the attachment of the esophagus to the wall of the heart.
Nowadays, methods of visualization of real anatomical structures are dynamically developed on the basis of data processing of DICOM computer and magnetic resonance imaging, including for the reconstruction of 3D anatomy of the heart.
Purpose of research. The task of the research was to construct a three-dimensional model of the anatomical structures of the heart and the nearby organs (pulmonary veins, esophagus) in EnSite Verismo software environment (St.Jude Medical, USA) and to implement the technique in clinical practice in order to improve the accuracy of visualization, safety and efficacy of RFA in X-ray conditions in real time.
Metodology. The research was carried out at the M.M. Amosov National Institute of Cardiovascular Surgery Ukraine NAMS of Ukraine with the use of modern specialized high-tech medical equipment and clinical materials, computer tomography images (CT) of the patient's heart N. obtained in the radiation diagnostics department and data of the electroanatomic mapping of the patient's heart in the department of treatment of arrhythmias with X-ray surgery.
The approach for conducting RFA with the EnSite Verismo software was implemented using the following algorithm:
  1. Receiving and preserving CT scans of the patient in the DICOM format.
  2. Downloading "gray" images into the EnSite Verismo software.
  3. Construction of a 3D model of anatomical structures of the heart, pulmonary veins and esophagus by the segmentation of CT images.
  4. Export of model to the EnSite NavX system (St. Jude Medical, USA).
  5. Combination of a segmented model and electroanatomical map in the EnSite NavX system for further radiofrequency ablation.
An algorithm for 3D segmentation of the left atrium, pulmonary veins and esophagus in the EnSite Verismo software is developed. It is based on the threshold method of splitting the image into an area for which a certain homogeneity criterion is fulfilled.
Result and conclusions. The developed algorithm for segmentation of the left atrium, pulmonary veins and esophagus for the EnSite Verismo allows for the construction of an exact anatomy of structures. The 3D model of individual anatomy of the heart provides the information for surgeon during RFA about the features of the structure of the left atrium: the location of the pulmonary veins in order to avoid vein stenosis; the localisation of the esophagus in order to apply ablation very carefully, so as not to make the perforation of the esophagus. A 3D model, supplemented by an electro-anatomical map of the left atrium that shows, in addition to anatomy, the order of activation of heart miocardium and localization of arrhythmia, will increase the efficiency and safety of RFA.

Keywords


computer tomography; radiofrequency ablation; EnSite Verismo software

References


Kirchhof P., Curtis A.B., Skanes A.C., Gillis A.M., Wann L.S. and Camm A.J. (2013) Atrial fibrillation guidelines across the Atlantic: a comparison of the current recommendations of the European Society of Cardiology/European Heart Rhythm Association/European Association of Cardiothoracic Surgeons, the American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society, and the Canadian Cardiovascular Society. European Heart Journal, Vol. 34, Iss. 20, pp. 1471-1474. DOI: 10.1093/eurheartj/ehs446

Barbhaiya C., Ng J. and Michaud G.F. (2015) Periprocedural care for catheter ablation of atrial fibrillation. Practical Guide to Catheter Ablation of Atrial Fibrillation, pp. 351-360. DOI: 10.1002/9781118658369.ch26

} Yanagisawa S., Inden Y., Kato H., Fujii A., Mizutani Y., Ito T., Kamikubo Y., Kanzaki Y., Ando M., Hirai M., Shibata R. and Murohara T. (2016) Effect and Significance of Early Reablation for the Treatment of Early Recurrence of Atrial Fibrillation After Catheter Ablation. The American Journal of Cardiology, Vol. 118, Iss. 6, pp. 833-841. DOI: 10.1016/j.amjcard.2016.06.045

Yan J., Wang C., Du R., Yuan W. and liang Y. (2013) Pulmonary vein stenosis and occlusion after radiofrequency Catheter Ablation for atrial fibrillation. International Journal of Cardiology, Vol. 168, Iss. 2, pp. e68-e71. DOI: 10.1016/j.ijcard.2013.07.060

Liu Y., Wang C., Zhao R., Wan D., Xie H., Jin G., Wang J., Lin L., Liu Q. and Bai R. (2013) Incidence and clinical characteristics of postcardiac injury syndrome complicating cardiac perforation caused by radiofrequency catheter ablation for cardiac arrhythmias. International Journal of Cardiology, Vol. 168, Iss. 4, pp. 3224-3229. DOI: 10.1016/j.ijcard.2013.04.011

Mateos J.C.P., Mateos E.I.P., Peña T.G.S., Lobo T.J., Mateos J.C.P., Vargas R.N.A., Pachón C.T.C. and Acosta J.C.Z. (2015) Simplified Method for Esophagus Protection during Atrial Fibrillation Radiofrequency Catheter Ablation - Prospective Study of 704 Cases. Revista Brasileira de Cirurgia Cardiovascular. DOI: 10.5935/1678-9741.20150009

Lundqvist C.B., Auricchio A., Brugada J., Boriani G., Bremerich J., Cabrera J.A., Frank H., Gutberlet M., Heidbuchel H., Kuck K., Lancellotti P., Rademakers F., Winkels G., Wolpert C. and Vardas P.E. (2013) The use of imaging for electrophysiological and devices procedures: a report from the first European Heart Rhythm Association Policy Conference, jointly organized with the European Association of Cardiovascular Imaging (EACVI), the Council of Cardiovascular Imaging and the European Society of Cardiac Radiology. Europace, Vol. 15, Iss. 7, pp. 927-936. DOI: 10.1093/europace/eut084

Arujuna A., Karim R., Zarinabad N., Gill J., Rhode K., Schaeffter T., Wright M., Rinaldi C.A., Cooklin M., Razavi R., O'Neill M.D. and Gill J.S. (2015) A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation. Europace, Vol. 17, Iss. 8, pp. 1241-1250. DOI: 10.1093/europace/euu364

Yarramaneni A.T., Conroy J., Flanagan J., Tang J., Pollack S., Koss E., Wang L., Reichek N., Cao J. and Kadiyala M. (2015) Assessment of left atrial volumes by 3D CT angiography and 2D echocardiography in patients undergoing atrial fibrillation ablation. Journal of the American College of Cardiology, Vol. 65, Iss. 10, pp. A1261. DOI: 10.1016/s0735-1097(15)61261-x

Alkhimova S.M. (2011) Segmentation algorithm of СT-images by using slices with contrast enhancement, Naukovi visti NTUU "KPI", No 1, pp. 33–41.

Harrison J.L., Jensen H.K., Peel S.A., Chiribiri A., Grøndal A.K., Bloch L., Pedersen S.F., Bentzon J.F., Kolbitsch C., Karim R., Williams S.E., Linton N.W., Rhode K.S., Gill J., Cooklin M., Rinaldi C., Wright M., Kim W.Y., Schaeffter T., Razavi R.S. and O'Neill M.D. (2014) Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study. European Heart Journal, Vol. 35, Iss. 22, pp. 1486-1495. DOI: 10.1093/eurheartj/eht560

Kiuchi K., Okajima K., Shimane A., Yokoi K., Teranishi J., Aoki K., Chimura M., Tsubata H., Miyata T., Matsuoka Y., Toba T., Ohishi S., Sawada T., Tsukishiro Y., Onishi T., Kobayashi S., Yamada S., Taniguchi Y., Yasaka Y., Kawai H., Ikeuchi K., Shigenaga Y. and Ikeda T. (2015) Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography. Journal of Arrhythmia, Vol. 31, Iss. 3, pp. 152-158. DOI: 10.1016/j.joa.2014.10.003

Suenari K., Nakano Y., Hirai Y., Ogi H., Oda N., Makita Y., Ueda S., Kajihara K., Tokuyama T., Motoda C., Fujiwara M., Chayama K. and Kihara Y. (2012) Left atrial thickness under the catheter ablation lines in patients with paroxysmal atrial fibrillation: insights from 64-slice multidetector computed tomography. Heart and Vessels, Vol. 28, Iss. 3, pp. 360-368. DOI: 10.1007/s00380-012-0253-6


GOST Style Citations


Atrial fibrillation guidelines across the Atlantic: a comparison of the current recommendations of the European Society of Cardiology/European Heart Rhythm Association/European Association of Cardiothoracic Surgeons, the American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society, and the Canadian Cardiovascular Society / P. Kirchhof, A.B. Curtis, A.C. Skanes et al. // European Heart Journal. - 2013. - Vol. 34, № 20. - P. 1471-1474.

Better lesion creation and assessment during catheter ablation / S. Kumar, C.R. Barbhaiya, S. Balindger et al. // Journal of Atrial Fibrillation. - 2015. - Vol. 8, № 3. - P. 62-73.

Effect and Significance of Early Reablation for the Treatment of Early Recurrence of Atrial Fibrillation After Catheter Ablation / S. Yanagisawa, Y. Inden, H. Kato et al. // The American Journal of Cardiology. - 2016. - Vol. 118, № 6. - P. 833-841.

Pulmonary vein stenosis and occlusion after radiofrequency Catheter Ablation for atrial fibrillation / J. Yan, C. Wang, R. Du et al. // International Journal of Cardiology. - 2013. - Vol. 168, № 2. - Р. 68-71.

Incidence and clinical characteristics of postcardiac injury syndrome complicating cardiac perforation caused by radiofrequency catheter ablation for cardiac arrhythmias / Y. Liu, C. Wang, R. Zhao et al. // International Journal of Cardiology. - 2013. - Volume 168, № 4. - P. 3224-3229.

Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation--prospective study of 704 cases. / J.C. Mateos, E.I. Mateos, T.G. Peña et al. // Revista Brasileira de Cirurgia Cardiovascular. - 2015. - Vol. 30, № 2. - P. 139-147.

The use of imaging for electrophysiological and devices procedures: a report from the first European Heart Rhythm Association Policy Conference, jointly organized with the European Association of Cardiovascular Imaging, the Council of Cardiovascular Imaging and the European Society of Cardiac Radiology / L.C Blomström, A. Auricchio, J. Brugada et al. // Europace. - 2013. - Vol. 15, № 7. - P. 927-937.

A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation / A. Arujuna, R. Karim, N. Zarinabad et al. // Europace. - 2015. - Vol. 17, № 8. - P. 1241-1250.

Assessment of left atrial volumes by 3d ct angiography and 2d echocardiography in patients undergoing atrial fibrillation ablation. / A. T. Yarramaneni, J. Conroy, J. Flanagan, J. Tang, J. Pollack, El. Koss, L. Wang, N. Reichek, J. Cao, M. Kadiyala. / / The Journal of the American College of Cardiology. - 2015. - Vol. 65., № 10. -- P. 409-410.

Алгоритм сегментації зображень комп’ютерної томографії на основі використання зрізів з контрастним посиленням тканин / С.М. Алхімова // Наукові вісті НТУУ “КПІ”. - 2011. - № 1. - С. 33–41.

Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study / J.L. Harrison, H.K. Jensen, S.A. Peel et al. // European Heart Journal. - 2014. - Vol. 35, № 22. - P. 1486–1495.

Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography / K. Kiuchi, K. Okajima, A. Shimane et al. // Journal of Arrhythmia. - 2015. - Vol. 31, № 3. - P. 152-158.

Left atrial thickness under the catheter ablation lines in patients with paroxysmal atrial fibrillation: insights from 64-slice multidetector computed tomography / K. Suenari, Y. Nakano, Y. Hirai et al. // Heart Vessels. - 2013. - Vol. 28, № 3. - P. 360-368.




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