Integration of three-dimensional left atrial magnetic resonance images into a real-time electroanatomic mapping system: Validation of a registration method

Background: The alignment of three-dimensional (3D) left atrial images acquired by magnetic resonance (MR) with the anatomical information yielded by 3D mapping systems is one of the most critical issues in image integration techniques for catheter ablation of atrial fibrillation (AF). We assessed the accuracy of a simplified method of superimposing 3D MR left atrial images on real-time left atrial electroanatomic maps (registration). Methods: MR data on the left atrium in 40 patients with drug-refractory AF were imported into the CartoMerge (TM) (Biosense Webster, Inc., Diamond Bar, CA, USA) electroanatomic mapping system. Registration was obtained by combining "visual alignment" of one endocardial point and "surface registration" of a limited number of points sampled on the posterior wall of the left atrium. The accuracy of the registration process was assessed through a statistical algorithm incorporated into the CartoMerge (TM) system, and through the percentage of pulmonary veins (PVs) in which electrical isolation was achieved after anatomical ablation. Results: The mean registration surface-to-point distance and ablation surface-to-point distance were 1.33 +/- 0.96 mm and 1.47 +/- 1.15 mm, respectively. Upon completion of the circumferential anatomical ablation around the PVs, electrical PV isolation was confirmed by a multipolar circular mapping catheter in 129 of 146 PVs (89%). Conclusions: Our registration method, which is mainly based on the surface registration of the posterior wall of the left atrium, enables almost 90% of PVs to be isolated by means of an anatomically based catheter ablation approach.