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Background Catheter ablation (CA) of atrial fibrillation (AF) has become a very common therapy. Considering risks of irradiation exposure, a reduction of fluoroscopy during AF ablation procedures is essential. The UNIVU module, a fluoroscopy image integration module in the CARTO 3 system, aims to reduce irradiation exposure. We sought to evaluate irradiation exposure evolution in our centre during CA of AF since the installation of UNIVU module. Methods and results Retrospective, monocentric study, including 266 AF catheter ablation (CA) from 01/2016 to 09/2019, with 181 radiofrequency (RF) CA and 85 cryotherapy CA, performed by a single operator. RF procedure performed with CARTO 3 only (n = 59) were compared to those with CARTO 3 and UNIVU (n = 122) in terms of fluoroscopy time (FT), dose area product (DAP) and estimated effective dose (ED). The same parameters were collected for cryotherapy procedure during the same period as a comparator. Median FT, DAP and ED were significantly reduced in the “CARTO3 + UNIVU” group compared to the “CARTO 3” group, respectively ( Fig. 1 ). An improvement in the use of the tool resulted in a higher reduction of irradiation in the 2nd year of UNIVU use, to reach a median DAP of 91 cGy.cm2 [IQ 44–201] and median ED of 0.2mSv [IQ 0.1–0.4] in the “CARTO3 + UNIVU” group (P Conclusion The use of the UNIVU module reduces drastically the irradiation during RF ablation procedures of AF.

Ventricular arrhythmias arise from complex electroanatomical substrates in patients with structural heart disease. There have been significant advancements in technologies and techniques for ventricular tachycardia catheter ablation. A systematic approach to mapping and ablation is paramount, and catheter ablation has shifted to be a potential first-line therapy for patients needing early intervention, particularly for those with post-infarction arrhythmias. Furthermore, imaging integration, coupled with a systematic, detailed substrate characterization, has shown promise and provides a safe and effective approach for long-term arrhythmia control.

Aims During ablation in the vicinity of the coronary arteries establishing a safe distance from the catheter tip to the relevant vessels is mandatory and usually assessed by fluoroscopy alone. The aim of the study was to investigate the feasibility of an image integration module (IIM) for continuous monitoring of the distance of the ablation catheter tip to the main coronary arteries during ablation of ventricular arrhythmias (VA) originating in the sinus of valsalva (SOV) and the left ventricular summit part of which can be reached via the great cardiac vein (GCV). Methods and results Of 129 patients undergoing mapping for outflow tract arrhythmias from June 2014 till October 2015, a total of 39 patients (52.4 ± 18.1 years, 17 female) had a source of origin in the SOV or the left ventricular summit. Radiofrequency (RF) ablation was performed when a distance of at least 5 mm could be demonstrated with IIM. A safe distance in at least one angiographic plane could be demonstrated in all patients with a source of origin in the SOV, whereas this was not possible in 50% of patients with earliest activation in the summit area. However, using the IIM a safe position at an adjacent site within the GCV could be obtained in three of these cases and successful RF ablation performed safely without any complications. Ablation was successful in 100% of patients with an origin in the SOV, whereas VAs originating from the left ventricular summit could be abolished completely in only 60% of cases. Conclusion Image integration combining electroanatomical mapping and fluoroscopy allows assessment of the safety of a potential ablation site by continuous real-time monitoring of the spatial relations of the catheter tip to the coronary vessels prior to RF application. It aids ablation in anatomically complex regions like the SOV or the ventricular summit providing biplane angiograms merged into the three-dimensional electroanatomical map.

Background Premature ventricular contractions (PVCs) from left ventricular (LV) summit remain challenging for the risk of coronary artery injury. Computed tomographic or intracardiac echocardiography may be helpful, but both still have many limitations. CartoUNIVU module has rarely been used in PVC ablation. Methods A total of 22 patients (14 men: mean age 56.4 ± 13.3 years) with an electrocardiogram indication of summit PVCs were included in the two centers study. A novel strategy ablation with the Image Integration Module CartoUNIVUTM module was performed for all the patients with PVCs originating from LV summit area, especially to prevent the coronary artery injury. Results The procedure time was 78.6 ± 22.7 minutes, and the fluoroscopy time was 12.5 ± 3.1 minutes. The distance between the target and nearest coronary artery was 8.0 ± 3.1 mm. Three patients with the distance to the nearest coronary artery

Aims An appropriate left ventricular (LV) lead position is a pre-requisite for response to cardiac resynchronization therapy (CRT) and is highly patient-specific. The purpose of this study was to develop a non-invasive pre-procedural CRT-roadmap to guide LV lead placement to a coronary vein in late-activated myocardium remote from scar. Methods and results Sixteen CRT candidates were prospectively included. Electrocardiographic imaging (ECGI), computed tomography angiography (CTA), and delayed enhancement cardiac magnetic resonance imaging (DE-CMR) were integrated into a 3D cardiac model (CRT-roadmap) using anatomic landmarks from CTA and DE-CMR. Electrocardiographic imaging was performed using 184 electrodes and a CT-based heart-torso geometry. Coronary venous anatomy was visualized using a designated CTA protocol. Focal scar was assessed from DE-CMR. Cardiac resynchronization therapy-roadmaps were constructed for all 16 patients [left bundle branch block: n = 6; intraventricular conduction disturbance: n = 8; narrow-QRS (ablate and pace strategy); n = 1; right bundle branch block: n = 1]. The number of coronary veins ranged between 3 and 4 per patient. The CRT-roadmaps showed no (n = 5), 1 (n = 6), or 2 (n = 5) veins per patient located outside scar in late-activated myocardium [≥50% QRS duration (QRSd)]. Final LV lead position was outside scar in late-activated myocardium in 11 out of 14 implanted patients, while a LV lead in scar was unavoidable in the remaining three patients. Conclusion A non-invasive pre-implantation CRT-roadmap was feasible to develop in a case series by integration of coronary venous anatomy, myocardial-scar localization, and epicardial electrical activation patterns, anticipating on clinically relevant features.

Linux containers have gained widespread use in high energy physics, be it for services using container engines such as containerd/kubernetes, for production jobs using container engines such as Singularity or Shifter, or for development workflows using Docker as a local container engine. Thus the efficient distribution of the container images, whose size usually ranges from a few hundred megabytes to a few tens of gigabytes, is becoming a pressing concern. Because container images show similar characteristics than scientific application stacks, unpacking the images in CernVM-FS can remedy the distribution issues provided that the container engine at hand is able to use such unpacked images from CernVM-FS. In this contribution, we willl report on recent advances in the integration of Singularity, Docker, and containerd with CernVM-FS. We show improvements in the publishing of container images from a Docker registry that rely on new means of directly ingesting image tarballs. Well also show a repository file system structure for storing container images that are optimized for storing both container engines using flat root file systems (Singularity) as well as container engines using layers (containerd, Docker). To evaluate the benefits of our approach, we show concrete use cases and figures for production and development images from LHC experiments stored in the recently created unpacked.cern.ch repository.

Background: The conventional index for ablation accuracy is to compare the distance between mapping points with and without treatment by using image integration. We attempted to quantitatively evaluate the role of angle as an index in the ablation accuracy in patients with atrial fibrillation (AF). Methods: A total of 48 patients with AF were included in the present study. Virtual fluoroscopy planes were predicted by pulmonary vein (PV) angiography, and the standard image planes were defined on the basis of the computed tomography images. Ablations were performed, guided by image integration; and the ablation planes were defined by the actual ablation rings. The predicted angle (distance) was defined as the angle (distance) between the fluoroscopy (predicted) plane and image (standard) plane, whereas the actual angle (distance) was defined as the angle (distance) between the ablation (actual) planes and the image (standard) planes. Results: We found that all actual angles were significantly smaller than the predicted angles (P .05). Conclusion: Our finding indicates that both the angle and the distance can be significantly reduced by navigation with image integration, but that the angle exhibited better sensitivity than the conventional index of distance. We suggest that the angle should be considered as a new index for ablation accuracy.

BACKGROUND We present a new, easily applicable approach for the guidance of cryoballoon (CB) pulmonary vein isolation (PVI) procedures that use the combination of a 3D-mapping system image integration module and computed tomographic (CT)-derived anatomy. The aim of this retrospective, nonrandomized study was to investigate: (a) an alternative use for an established radiofrequency image integration module for cryo procedures; (b) a guidance technology for cryo PVI based on integrated CT anatomy; and (c) its clinical impact. METHODS AND RESULTS CT left atrium-angiography was performed in 50 consecutive patients before a CB PVI procedure, and a 3D reconstruction of the cardiac anatomy was segmented. A total of 25 patients were treated using conventional fluoroscopy; 25 patients were treated using the 3D image integration technique. In the image integration group, the CARTO3 UNIVU (Biosense Webster) module was used for image integration of 3D anatomy and fluoroscopic imaging. Transseptal puncture and cryo PVI were guided by 3D-overlay imaging. Procedures were feasible without complications in all patients and cryo PVI procedures were successfully guided using the image integration technique. The intraprocedural time needed to perform image integration was 37 ± 10 seconds. Fluoroscopy time was 31.7 ± 11.7 minutes in the conventional group and 20.1 ± 7.9 minutes in the image integration group (P

Photovoltaic (PV) plant monitoring is recently representing an important field in the energy market, due to the large diffusion of PV plants, often built with low technical standards in the past decade and lack of accuracy in O&M activities after the first 5-year life of the plant. In this paper, the authors proposed an expert system that, based on the image integration obtained by means of Unmanned Aerial Vehicles (UAVs), is able to identify some defects in PV modules and to analyze from an economical point the impact of these defects.

Catheter ablation of atrial fibrillation has evolved enormously thanks to rapid improvement of modern mapping technologies, progress in catheter development and current possibilities for reduction of radiation exposure. Pulmonary vein isolation is thereby the cornerstone in this interventional treatment. Increased precision of catheter localization by modern three-dimensional mapping systems, faster and better processing of local electrograms and their immediate color-based visualization make it possible to treat even challenging arrhythmias very effectively. The commonly used three-dimensional mapping systems CARTO 3 (Biosense Webster, Irvine, Ca.) and Ensite Precision (St. Jude Medical, St. Paul, Min) differ in construction and principles of the underlying mapping technology. In this review article, we aim to emphasize the most important aspects of possibilities that make both systems so valuable for interventional treatment of atrial fibrillation. We present a modern workflow, that unites three-dimensional LA mapping with collecting relevant local information, image integration for refining the map and beneficial use of contact force based ablation approach.

In this review, we outline contemporary and upcoming electroanatomic technologies focusing on new mapping tools especially in catheter ablation for atrial fibrillation. The number of catheter ablations has been increasing exponentially in the last few years due to technological advancements enabling complex ablation strategies. The quality of the contemporary systems of electroanatomic mapping is sufficiently high in terms of both standard ablations, such as isolation of pulmonary veins, and evaluation and elimination of complex arrhythmias. New instruments and devices are coming out to facilitate the process of understanding arrhythmias and thus simplify their elimination. The trend shows a deflection from fluoroscopy towards more advanced technologies.

The presence of high-density objects remains an open problem in medical CT imaging. Data of projections that passing through such objects are dominated by noise. Reconstructed images become less diagnostically conclusive because of pronounced artifacts that manifest as dark and bright streaks. A new reconstruction algorithm is proposed, which incorporates information gained from a prior image. Based on a non-local regularization, these information are used to reduce streaking artifacts. In an iterative scheme, the prior image is transformed in order to match intermediate results of the reconstruction by solving a registration problem. During iterations, temporally appearing artifacts are reduced with a bilateral filter and projection values passing through high-density objects are replaced by new calculated values, which are used further on for the reconstruction. Results show that the proposed algorithm significantly reduces streaking artifacts.

Reducing Radiation Exposure Introduction Reduction of radiation exposure during cardiac arrhythmia ablation procedures is desirable. We sought to evaluate the utility of a new image integration module (CARTOUNIVUTM) in reducing fluoroscopy times and dosages during left atrial arrhythmia (LAA) and ventricular tachycardia (VT) ablation procedures. Methods and Results Consecutive patients undergoing LAA (n = 28)/VT (n = 13) ablation using the CARTOUNIVUTM module were included. Total fluoroscopy time, radiation dose (total dose area product [tDAP], effective dose [ED]), and procedure duration were evaluated. A retrospective cohort of patients who underwent LAA (n = 16)/VT(n = 8) ablation without the new image integration module served as a control group. The use of the new image integration module significantly reduced mean fluoroscopy time (5.2 minutes [IQR 1.9;6.8] in the LAA ablation UNIVU group vs. 28.2 minutes [IQR 15.3;37.8] in the control group, P

Arrhythmia management in patients with adult congenital heart disease (ACHD) is a challenge on many levels, as tachycardic episodes may lead to hemodynamic impairment in otherwise compensated patients even if episodes are only transient. Recently several technical advances, including 3-dimensional (3D) image integration, 3D mapping, and remote magnetic navigation, have been introduced to facilitate curatively intended ablation procedures in patients with ACHD. This review attempts to outline the role of a novel technology of simultaneous, noninvasive mapping in this patient cohort, and gives details of the authors' single-center experience.

Background: Long-term results of substrate modification for ablation of ventricular tachycardia (VT) have not been reported. We report long-term outcomes of substrate elimination targeting local abnormal ventricular activities (LAVA) for post–myocardial infarction VT. Methods and Results: One hundred fifty-nine consecutive patients undergoing first ablation were included (65±11 years, 92% implantable cardioverter defibrillators, 54% storms, and 73% appropriate shocks). LAVA were identified in 92% and VT was inducible in 73%. Complete LAVA elimination and noninducibility after ablation were achieved in 64% and 85%. During a median follow-up of 47 months (interquartile range, 34–82), single-procedure ventricular arrhythmia (VA)–free survival was 55% (10% storms and 19% shocks). The VA-free survival was 73%, 68%, 61%, 55%, and 49% after 1, 2, 3, 4, and 5 years, respectively. Complete LAVA elimination was associated with improved outcomes: VA-free survival of 82% at 1 year and 61% at 5 years. In the subgroup treated with multielectrode mapping and real-time image integration, VA-free survival was 86% and 65% at 1 year and 4 years, respectively. Including repeat procedures in 18% of pts (1.3±0.6 ablations/pt) outcomes improved to 69% VA-free survival (2% storms and 9% shocks) during median 46-month follow-up. Overall survival was 91% at 1 year and 77% at 5 years of follow-up. Conclusions: In this monocentric study, substrate modification targeting LAVA for post–myocardial infarction VT resulted in a substantial reduction of VT storm and implantable cardioverter defibrillator shocks and up to 49% of patients free from arrhythmia at 5 years after a single procedure. Complete LAVA elimination, multielectrode mapping, and real-time integration were associated with improved VA-free survival.

Summary Objective We present a single‐center prospective study, validating the use of 3D multimodality imaging (3DMMI) in patients undergoing intracranial electroencephalography (IC‐EEG). Methods IC‐EEG implantation preparation entails first designing of the overall strategy of implantation (strategy) and second the precise details of implantation (planning). For each case, the multidisciplinary team made decisions on strategy and planning before the disclosure of multimodal brain imaging models. Any changes to decisions, following disclosure of the multimodal models, were recorded. Results Disclosure of 3DMMI led to a change in strategy in 15 (34%) of 44 individuals. The changes included addition and subtraction of electrodes, addition of grids, and going directly to resection. For the detailed surgical planning, 3DMMI led to a change in 35 (81%) of 43 individuals. Twenty‐five (100%) of 25 patients undergoing stereo‐EEG (SEEG) underwent a change in electrode placement, with 158 (75%) of 212 electrode trajectories being altered. Significance The use of 3DMMI makes substantial changes in clinical decision making.

Catheter ablation has an important role in the management of patients with ventricular tachycardia (VT) but is limited by modest long-term success rates. Magnetic resonance imaging (MRI) can provide valuable anatomic and functional information as well as potentially improve identification of target sites for ablation. A major limitation of current MRI protocols is the spatial resolution required to identify the areas of tissue responsible for VT but recent developments have led to new strategies which may improve substrate assessment. Potential ways in which detailed information gained from MRI may be utilized during electrophysiology procedures include image integration or performing a procedure under real-time MRI guidance. Image integration allows pre-procedural magnetic resonance (MR) images to be registered with electroanatomical maps to help guide VT ablation and has shown promise in preliminary studies. However, multiple errors can arise during this process due to the registration technique used, changes in ventricular geometry between the time of MRI and the ablation procedure, respiratory and cardiac motion. As isthmus sites may only be a few millimetres wide, reducing these errors may be critical to improve outcomes in VT ablation. Real-time MR-guided intervention has emerged as an alternative solution to address the limitations of pre-acquired imaging to guide ablation. There is now a growing body of literature describing the feasibility, techniques, and potential applications of real-time MR-guided electrophysiology. We review whether real-time MR-guided intervention could be applied in the setting of VT ablation and the potential challenges that need to be overcome.

This research aims at analyzing the integration of C and X band data collected from Radarsat2 (RS2) and COSMO-SkyMed (CSK) systems on two Italian test areas, located in South-Tyrol and in Tuscany, close to Florence, to estimate soil moisture (SMC, in %) and vegetation biomass (PWC, in kg/m2). Two retrieval approaches based on Support Vector Regression (SVR) and Artificial Neural Network (ANN) have been applied to these areas. Looking at the preliminary results, it has been noted that the integration of X and C band images could provide valuable information for the retrieval of SMC, even though further investigations should be carried out on a larger time-series and set of samples. On the South Tyrol test area, SVR methods provided an accuracy in the estimate of SMC with determination coefficient, R2> 0.85 and root mean square error, RMSE

Idiopathic left ventricular outflow tract ventricular arrhythmias (LVOT-VAs) arising from the LVOT are rare compared with the VAs arising from the RVOT. Idiopathic LVOT-VAs have been divided into four subgroups based on successful catheter ablation sites: the aorto-mitral continuity (AMC), the anterior site around the mitral annulus (MA), the aortic sinus cusps (ASC), and the epicardium. Recognition of the ECG characteristics of LVOT-VAs combined with anatomical information should facilitate their appropriate diagnosis and treatment. In particular, the AMC is located adjacent to the anterior site of the MA, ASC, and epicardium. All subtypes of LVOT-VAs, except those with epicardial origins, are successfully treated with endocardial radiofrequency catheter ablation combined with pace mapping and the identification of the earliest ventricular electrogram with a prepotential, if it is recordable. In addition, LVOT-VAs originating from an inaccessible area in the LV summit of the epicardium, which cannot be treated by epicardial catheter ablation, should be differentiated from those in an accessible area using novel electrophysiological characteristics. Despite many morphological similarities among the subtypes of LVOT-VAs, the ECG characteristics and anatomical information obtained from visualization using computed tomographic image integration with electroanatomical mapping may advance the safety and success of catheter ablation of idiopathic LVOT-VAs.

The motivation we address in this paper is to find out a generic method used to classify conceptual satellite image taken in multiband imagery. Predefined training image with different imagery bands is considered to test the proposed classification method. The Korhunen-Loeve (KL) transform is first employed to create newly integrated image with dense information and best contrast due to the information of all used bands are concentrated in one integral image. Then, the integrated image is partitioned into variable sized blocks using hybrid horizontal-vertical (HHV) partitioning method. The size of blocks is determined automatically according to the spectral uniformity measurements. Later, ant colony optimization (ACO) is used to find out the optimal number of classes that may exist in the image, and then classify the image in terms of the discovered classes. It was found that the obtained classification results by ACO are in a good agreement with the actual training data, which ensure the success of the proposed method and the effective performance of the classification.

Papillary muscles (PMs) were reported to be origin of ventricular arrhythmia (VA). Radiofrequency (RF) ablation was reported to be acutely effective in eliminating VA. However, the recurrence rate is high. Recently, cryoablation guided by intracardiac echocardiography, 3-dimensional mapping system, and image integration was introduced as alternative strategy for this challenging ablation. We present a case of ventricular tachycardia originating from anterior PM of left ventricle treated by cryoablation guided only by intracardiac echocardiography.

To investigate the impact of using computed tomography (CT) and contact force (CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation (AF) ablation.This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation (PVI) for AF during 2012 and 2013 guided by CT image integration (Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping (EAM) system (CT group) using standard irrigated radiofrequency catheter (ThermoCool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor (Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter (ThermoCool) using only EAM (Carto) system (EAM group). Linear lesions were performed according to the discretion of operator.Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group (81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant (73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up (100% vs 73%; respectively; P = 0.07). Major complications (pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.

The growing number of atrial fibrillation catheter ablation procedures warranted the development of advanced cardiac mapping techniques, such as image integration between electroanatomical map and cardiac computed tomography. While scanning the chest before catheter ablation, it is frequent to detect cardiac and extracardiac collateral findings. Most collateral findings are promptly recognized as benign and do not require further attention. However, sometimes clinically relevant collateral findings are detected, which often warrant extra diagnostic examinations or even invasive procedure, and sometimes need to be followed-up over time. Even though reporting and further investigating collateral findings has not shown a clear survival benefit, almost all the working groups providing data on collateral findings reported some collateral findings eventually coming out to be malignancies, sometimes at an early stage. Therefore, there is currently no clear agreement about the right strategy to be followed.

Over the past decade, electroanatomic mapping has emerged as a useful tool for complex ablation procedures. A more recent advancement is the development of image integration. Image integration refers to the process of registering a previously acquired MRI or CT scan of the heart with the mapping space during the ablation procedure. The technique of image integration is now relied on by many electrophysiology laboratories to guide complex ablation procedures, particularly atrial fibrillation ablation and ablation of patients with ventricular tachycardia in the setting of structural heart disease. An even more recent development is image fusion. This refers to taking information about the myocardial substrate, especially intramyocardial scar, and registering it with the active mapping space. This technique remains in its infancy but shows great promise in facilitating complex ablation procedures. The purpose of the article is to review the development, state of the art, and future of these image integration and fusion techniques.

The previously unknown congenital absence of inferior vena cava, an otherwise benign condition, may create difficulties for catheter ablation of arrhythmias. We describe a case of a typical-like atrial flutter, in which magnetic navigation was important for conserving the femoral approach. Electroanatomic mapping with image integration helped define the critical isthmus between the ostia of the suprahepatic veins and the tricuspid valve.

DynaCT Cardiac Integration into Electroanatomical Mapping. Introduction: Exact visualization of complex left atrial (LA) anatomy is crucial for safety and success rates when performing catheter ablation of atrial fibrillation (AF). The aim of our study was to validate the accuracy of integrating rotational angiography-based 3-dimensional (3D) reconstructions of LA and pulmonary vein (PV) anatomy into an electroanatomical mapping (EAM) system. Methods and Results: In 38 patients (62 ± 8 years, 25 females) undergoing catheter ablation of paroxysmal (n = 19) or persistent (n = 19) AF, intraprocedural rotational angiography of LA and PVs was performed. The subsequent 3D reconstruction and segmentation of LA and PVs was transferred to the EAM system and registered to the EAM. The distances of all EAM points to corresponding points on the LA syngo® DynaCT Cardiac surface were calculated. Segmentation of LA with clear visualization of adjacent structures was possible in all patients. Also, the integrated segmentation of the LA was used to guide the encirclement of ipsilateral veins, which resulted in PV isolation in all patients. Integration into the 3D mapping system was achieved with a distance error of 2.2 ± 0.4 mm when compared with the EAM surface. Subgroups with paroxysmal and persistent AF showed distance errors of 2.3 ± 0.3 mm and 2.1 ± 0.4 mm, respectively (P = n.s.). Conclusion: Intraprocedural registration of LA and PV anatomy by contrast enhanced rotational angiography was feasible and accurate. There were no differences between patients with paroxysmal or persistent AF. Therefore, integration of rotational angiography-based reconstructions into 3D EAM systems might be helpful to guide catheter ablation for AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 278–283, March 2010)

The purpose of this study is about becomes the foundation which establishes the area image integrated strategy the area image and the major factor of the Cho-jeong. For a study result area image integration the considered seriously was self-combustion and creativity, according to demographics quality the possibility of knowing the fact that partially is difference of recognition. This will lead and for an area image integration from and will be natural to use the delegation of a district resources, the image integrated strategy which is discriminated must be established and the possibility.

Aims To evaluate the feasibility of integrating three-dimensional images created by intra-procedural cone-beam computed tomography (CBCT) into three-dimensional electroanatomical maps (EAM) and compare its accuracy with that of pre-procedural multi-slice CT (MSCT). Methods and results In 24 patients with drug-refractory atrial fibrillation (AF), atriography using CBCT with pulmonary arterial contrast injection was performed at the beginning of the AF ablation procedure. Intra-procedural CBCT images and pre-procedural MSCT images were individually imported into the EAM system and compared their integration accuracy (point-to-surface distance) of each image and EAM just before ablation. The CBCT images were assessed qualitatively and quantitatively in comparison with MSCT images. All CBCT images were graded as optimal or useful in delineating the left atrium–pulmonary vein anatomy and were successfully integrated with the EAM. Overall, integration accuracy was similar for CBCT and MSCT. However, in 11 patients, the MSCT was performed 5 or more days prior to EAM, resulting in significantly shorter surface-to-point distance in CBCT than that in MSCT ( P = 0.047). Radiation exposure with CBCT was significantly reduced compared with MSCT ( P < 0.001). Conclusion It is feasible to integrate CBCT image into EAM, and the integration is relatively accurate. Intra-procedural atriography by CBCT may replace pre-procedural MSCT as the imaging source for image integration.