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Surrogate electro-anatomic-derived geometries are used as the three-dimensional (3D) basis for mapping of cardiac arrhythmias. While merged computed tomography (CT) imaging may provide stellar pulmonary vein (PV) and left atrial (LA) anatomy, the applied scans must be obtained prior to ablation, and may not reflect physiologic conditions at the time of intervention. Patient-specific, ultrasound-derived 3D imaging has been developed as an alternative basis for new generation electro-anatomic mapping. An electro-anatomic sensor positioned at the tip of the phased-array intracardiac ultrasound catheter, provides the means to specify both location and orientation of each image as the 'context' for creating the 3D volumes for co-registration with electro-anatomic mapping. Specific anatomic details such as the pulmonary veins, membranous fossa, papillary muscles, or valve structures derived from real-time imaging can also be integrated into each segmented volume. This presentation reviews the basis and methods for this novel multi-modality image fusion for the creation of robust, nearly real-time anatomic images for guiding electro-anatomic mapping and ablation without requiring pre-acquired CT image sets, with accompanying limitations.

Objective To define the apparent changes in ventricular fibrillation (VF) as cause of out-of-hospital cardiac arrest. (OHCA) Methods Retrospective analysis of prospectively acquired observational data of OHCA in a population-controlled setting with a single emergency medical service (EMS) system between 1991-2004. Results In the study period there were 338 all-cause arrests, with 203 (57%) in homes, 85 (24%) in public locations, and 69 (19%) in other locations (hotels, nursing homes). VF incidence during 1991-1997 was 24/100 000/person-yr and during 1998-2004 it was 11/100 000/person-yr (p