Image integration of three-dimensional cone-beam computed tomography angiogram into electroanatomical mapping system to guide catheter ablation of atrial fibrillation.

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). 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). 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.