Contrast-Enhanced C-Arm CT Evaluation of Radiofrequency Ablation Lesions in the Left Ventricle

JACC-CARDIOVASCULAR IMAGING

卷:4

Article

Girard, Erin E.^1,2  Rosenberg, Jarrett³  Luong, Richard⁴  Moore, Teri⁵  Lauritsch, Guenter⁶  Boese, Jan⁶  Fahrig, Rebecca³ 

[1] Stanford Univ, Dept Bioengn, Palo Alto, CA 94304 USA

[2] Stanford Univ, Dept Med, Palo Alto, CA 94304 USA

[3] Stanford Univ, Dept Radiol, Palo Alto, CA 94304 USA

[4] Stanford Univ, Dept Comparat Med, Palo Alto, CA 94304 USA

[5] Siemens Med Solut Inc, Malvern, PA USA

[6] Siemens AG, Healthcare Sector, Forchheim, Germany

关键词: arrhythmia;    C-arm computed tomography;    catheter ablation;    computed tomography;    electrophysiology;    imaging;   

DOI  :  10.1016/j.jcmg.2010.11.019

来源: Elsevier

【 摘 要 】

OBJECTIVES The purpose of this study was to evaluate use of cardiac C-arm computed tomography (CT) in the assessment of the dimensions and temporal characteristics of radiofrequency ablation (RFA) lesions. This imaging modality uses a standard C-arm fluoroscopy system rotating around the patient, providing CT-like images during the RFA procedure. BACKGROUND Both cardiac magnetic resonance (CMR) and CT can be used to assess myocardial necrotic tissue. Several studies have reported visualizing cardiac RFA lesions with CMR; however, obtaining CMR images during interventional procedures is not common practice. Direct visualization of RFA lesions using C-arm CT during the procedure may improve outcomes and circumvent complications associated with cardiac ablation procedures. METHODS RFA lesions were created on the endocardial surface of the left ventricle of 9 swine using a 7-F RFA catheter. An electrocardiographically gated C-arm CT imaging protocol was used to acquire projection images during iodine contrast injection and after the injection every 5 min for up to 30 min, with no additional contrast. Reconstructed images were analyzed offline. The mean and SD of the signal intensity of the lesion and normal myocardium were measured in all images in each time series. Lesion dimensions and area were measured and compared in pathologic specimens and C-arm CT images. RESULTS All ablation lesions (n = 29) were visualized and lesion dimensions, as measured on C-arm CT, correlated well with postmortem tissue measurements (linear dimensions: concordance correlation = 0.87; area: concordance correlation = 0.90. Lesions were visualized as a perfusion defect on first-pass C-arm CT images with a signal intensity of 95 HU lower than that of normal myocardium (95% confidence interval: -111 HU to -79 HU). Images acquired at 1 and 5 min exhibited an enhancing ring surrounding the perfusion defect in 24 lesions (83%). CONCLUSIONS RFA lesion size, including transmurality, can be assessed using electrocardiographically gated cardiac C-arm CT in the interventional suite. Visualization of RFA lesions using cardiac C-arm CT may facilitate the assessment of adequate lesion delivery and provide valuable feedback during cardiac ablation procedures. (J Am Coll Cardiol Img 2011;4:259-68) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

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