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Gerhard Hindricks - One of the best experts on this subject based on the ideXlab platform.

  • efficacy and safety of remote magnetic Catheter Navigation vs manual steerable sheath guided ablation for Catheter ablation of atrial fibrillation a case control study
    Europace, 2015
    Co-Authors: Emmanuel Koutalas, Gerhard Hindricks, Sascha Rolf, Phillip Sommer, Andreas Bollmann, Sergio Richter, Livio Bertagnolli, Ole A Breithardt, Arash Arya
    Abstract:

    Aims Data comparing remote magnetic Catheter Navigation (RMN) to manual Catheter Navigation (MCN) using steerable sheath for ablation of atrial fibrillation (AF) is lacking. The aim of the present case–control study was to seek AF recurrence data after AF ablation using RMN in comparison to MCN using steerable sheath in patients with either paroxysmal or persistent AF. Methods and results This study comprised 140 patients with AF (50% paroxysmal). Seventy were ablated utilizing RMN and 70 with MCN. Primary endpoint was defined as the time to first recurrence after index procedure. After 28.8 ± 18.9 months of follow-up, more patients in the MCN group using steerable sheath remained free of recurrence compared with RMN group [(59.1 vs. 40%, respectively, P = 0.031), in patients with persistent AF P = 0.057, while in patients with paroxysmal AF, P = 0.18]. Index procedure time (223.6 ± 44.2 vs. 170.8 ± 51.8 min, P < 0.001) and radiofrequency application time (75.4 ± 20.9 vs. 56.6 ± 24.9 min, P < 0.001) were longer in the RMN group; however, the respective total fluoroscopy time (13.7 ± 7.8 vs. 36.6 ± 12.7 min, P < 0.001) was significantly shorter. In multivariable Cox-regression analysis, RMN was the only factor independently associated with shorter time to first recurrence during follow-up ( P = 0.048). Complication rate did not differ significantly between groups ( P = 0.056), although the incidence of significant pericardial effusion was higher in the MCN group (3 cases vs. 0 in RMN group). Conclusion Although in patients with persistent AF, the recurrence rate is higher in RMN group, the outcome is comparable between RMN and MCN groups in patients with paroxysmal AF. A multicentre prospective randomized study is warranted to clarify this issue.

  • Three-dimensional real-time MRI-guided intracardiac Catheter Navigation
    European Heart Journal, 2013
    Co-Authors: Thomas Gaspar, Matthias Gutberlet, Christopher Piorkowski, Gerhard Hindricks
    Abstract:

    Electrophysiological (EP) procedures guided by real-time MRI are highly attractive. Previously, we have reported first in man usage of such diagnostic EP studies as well as RA isthmus ablation. Passive Catheter tracking, however, is one of the main limitations. Here, we present first results from MRI-guided active Catheter tracking used for real-time 3D intracardiac Navigation, mapping, and ablation. In a 60 kg swine, a 3D data set containing heart and …

  • initial experience in ablation of typical atrial flutter using a novel three dimensional Catheter tracking system
    Europace, 2013
    Co-Authors: Philipp Sommer, Gerhard Hindricks, Thomas Gaspar, Charlotte Eitel, Agnieszka Wojdylahordynska, Sascha Rolf, Arash Arya, Christopher Piorkowski
    Abstract:

    Aims Three-dimensional (3D) mapping has been established for clinical routine in an interventional electrophysiology (EP). Recently, a novel sensor-based 3D Catheter tracking system has been introduced integrating 3D non-fluoroscopic Catheter Navigation into the environment of pre-recorded 2D fluoroscopy [MediGuide™ Technology (MG)]. We are reporting on the first clinical experience for ablation of typical atrial flutter. First we aimed to demonstrate safety and feasibility of this new technique. Secondly, procedural aspects such as effectiveness, procedure, and fluoroscopy time should be evaluated. Methods and results Ten consecutive patients (100% male, age 68 ± 8 years) were ablated using MG technology. Two steerable diagnostic EP Catheters (MediGuide Enabled Livewire™ Catheter, SJM) were used for coronary sinus cannulation and anatomical cavo-tricuspidal isthmus (CTI) reconstruction within the EnSite NavX™ System (NavX). Ablation was performed with a conventional 8 mm tip ablation Catheter (IBI, SJM). In all 10 patients both sensor-equipped MG Catheters could be tracked non-fluoroscopically. Successful anatomical CTI reconstruction was performed and complete isthmus block was documented after the ablation. Total procedure duration was comparable with conventional procedures (55 ± 8 min). Usage of the MG tracking system resulted in a fluoroscopy time of 2.5 ± 2 min. No adverse events occurred during the procedures. Conclusions For the first clinical application of the MG technology in an interventional electrophysiology we found a stable system enabling excellent 3D orientation for spatial Catheter positioning on the basis of underlying pre-recorded cine loops. Clinically, the MG technology allowed successful procedures with short fluoroscopy times, even though a sensor-equipped ablation Catheter was not yet available for use in the study.

  • Catheter ablation of atrial fibrillation using remote magnetic Catheter Navigation a case control study
    Europace, 2011
    Co-Authors: Arash Arya, Thomas Gaspar, Christopher Piorkowski, Ruzbeh Zakershahrak, Phillip Sommer, Andreas Bollmann, Ulrike Wetzel, Sergio Richter, Daniela Husser, Gerhard Hindricks
    Abstract:

    Aims To compare the acute and the 6 month outcome of Catheter ablation of atrial fibrillation (AF) using irrigated tip magnetic Catheter and remote magnetic cathter Navigation (RMN) with manual Catheter Navigation (MCN) in patients with paroxysmal and persistent AF. Methods and results In this retrospective analysis 356 patients (235 male, mean age: 57.9 ± 10.9 years) with AF (70.5%, paroxysmal) who underwent Catheter ablation between August 2007 and May 2008 using either RMN ( n = 70, 46 male, mean age: 57.9 ± 10.1 years, 50% paroxysmal) or MCN ( n = 286, 189 male, mean age: 58.0 ± 13.9 years, 75.5% paroxysmal) were included. All patients completed an intensive follow-up strategy. Complete pulmonary vein isolation was achieved in 87.6 and 99.6% of patients in RMN and MCN groups, respectively ( P < 0.05). The procedure, fluoroscopy, and radiofrequency application times were 223 ± 44 vs. 166 ± 52 min ( P < 0.0001), 13.7 ± 7.8 vs. 34.5 ± 15.1 min ( P < 0.0001), and 75.4 ± 20.9 vs. 53.2 ± 21.4 min ( P < 0.0001) in RMN and MCN groups, respectively. Seven (10.0%) and 28 (9.8%) patients in RMN and MCN groups received antiarrhythmic medications during the follow-up ( P = 0.96). All the patients completed the 6 month follow-up. Freedom from AF at 6 months was achieved in 57.8 and 66.4% of the patients in RMN and MCN groups, respectively ( P = 0.196). In patients without previous AF Catheter ablation procedure the freedom from AF at 6 months were 68.2 and 60.5% in the MCN and RMN groups, respectively ( P = 0.36). Conclusion Catheter ablation using irrigated tip magnetic Catheter and RMN is an effective and safe method for Catheter ablation of AF. Compared to manual Catheter Navigation, the procedure and radiofrequency application times were longer and fluoroscopy time was shorter in the RMN group compared with the MCN group.

  • Catheter ablation of scar related ventricular tachycardia in patients with electrical storm using remote magnetic Catheter Navigation
    Pacing and Clinical Electrophysiology, 2010
    Co-Authors: Arash Arya, Thomas Gaspar, Christopher Piorkowski, Charlotte Eitel, Phillip Sommer, Andreas Bollmann, Ulrike Wetzel, Daniela Husser, Gerhard Hindricks
    Abstract:

    Background: A remote magnetic Navigation system (MNS) has been used for ablation of ventricular arrhythmias. However, irrigated tip Catheter has not been evaluated in large series of patients. Objective: To evaluate acute and long-term efficiency of the newly available irrigated tip magnetic Catheter for radiofrequency (RF) ablation of scar-related ventricular tachycardia (VT) in patients with ischemic heart disease. Methods: Between January 2008 and October 2009, a total of 30 consecutive patients with ischemic heart disease (26 men, age 70.1 ± 8.7 years, left ventricular ejection fraction: 30 ± 9%) and electrical storm due to monomorphic VT underwent RF ablation using a remote MNS and a magnetic irrigated tip Catheter. Results: Acute success was defined as noninducibility of any monomorphic VT during programmed right and left ventricular stimulation, and obtained in 24 (80%) patients. A total of 1–6 VTs (mean 2.3 ± 1.2, 394 ± 108 ms, 210–660 ms) were inducible during each procedure. The duration of RF energy application was 41.2 ± 23.3 minutes, with total procedure and fluoroscopy times of 158 ± 47 minutes and 9.8 ± 5.3 minutes, respectively. No acute complications were observed during the procedures. During mean follow-up of 7.8 months, 21 patients (70%) had no recurrence of VT and received no implantable cardioverter defibrillator therapy. Among patients who were noninducible during programmed right ventricular stimulation (n = 25), ≥1 monomorphic VT was inducible during programmed left ventricular stimulation in four (16%) that was ablated successfully in three of them. Conclusions: Irrigated ablation of scar-related VT using remote MNS is an effective modality for management of the monomorphic VT in patients with ischemic cardiomyopathy with minimal radiation exposure. Programmed left (in addition to right) ventricular stimulation might be necessary to assess acute outcome of the ablation procedure. (PACE 2010; 1312–1318)

Christopher Piorkowski - One of the best experts on this subject based on the ideXlab platform.

  • Three-dimensional real-time MRI-guided intracardiac Catheter Navigation
    European Heart Journal, 2013
    Co-Authors: Thomas Gaspar, Matthias Gutberlet, Christopher Piorkowski, Gerhard Hindricks
    Abstract:

    Electrophysiological (EP) procedures guided by real-time MRI are highly attractive. Previously, we have reported first in man usage of such diagnostic EP studies as well as RA isthmus ablation. Passive Catheter tracking, however, is one of the main limitations. Here, we present first results from MRI-guided active Catheter tracking used for real-time 3D intracardiac Navigation, mapping, and ablation. In a 60 kg swine, a 3D data set containing heart and …

  • initial experience in ablation of typical atrial flutter using a novel three dimensional Catheter tracking system
    Europace, 2013
    Co-Authors: Philipp Sommer, Gerhard Hindricks, Thomas Gaspar, Charlotte Eitel, Agnieszka Wojdylahordynska, Sascha Rolf, Arash Arya, Christopher Piorkowski
    Abstract:

    Aims Three-dimensional (3D) mapping has been established for clinical routine in an interventional electrophysiology (EP). Recently, a novel sensor-based 3D Catheter tracking system has been introduced integrating 3D non-fluoroscopic Catheter Navigation into the environment of pre-recorded 2D fluoroscopy [MediGuide™ Technology (MG)]. We are reporting on the first clinical experience for ablation of typical atrial flutter. First we aimed to demonstrate safety and feasibility of this new technique. Secondly, procedural aspects such as effectiveness, procedure, and fluoroscopy time should be evaluated. Methods and results Ten consecutive patients (100% male, age 68 ± 8 years) were ablated using MG technology. Two steerable diagnostic EP Catheters (MediGuide Enabled Livewire™ Catheter, SJM) were used for coronary sinus cannulation and anatomical cavo-tricuspidal isthmus (CTI) reconstruction within the EnSite NavX™ System (NavX). Ablation was performed with a conventional 8 mm tip ablation Catheter (IBI, SJM). In all 10 patients both sensor-equipped MG Catheters could be tracked non-fluoroscopically. Successful anatomical CTI reconstruction was performed and complete isthmus block was documented after the ablation. Total procedure duration was comparable with conventional procedures (55 ± 8 min). Usage of the MG tracking system resulted in a fluoroscopy time of 2.5 ± 2 min. No adverse events occurred during the procedures. Conclusions For the first clinical application of the MG technology in an interventional electrophysiology we found a stable system enabling excellent 3D orientation for spatial Catheter positioning on the basis of underlying pre-recorded cine loops. Clinically, the MG technology allowed successful procedures with short fluoroscopy times, even though a sensor-equipped ablation Catheter was not yet available for use in the study.

  • Catheter ablation of atrial fibrillation using remote magnetic Catheter Navigation a case control study
    Europace, 2011
    Co-Authors: Arash Arya, Thomas Gaspar, Christopher Piorkowski, Ruzbeh Zakershahrak, Phillip Sommer, Andreas Bollmann, Ulrike Wetzel, Sergio Richter, Daniela Husser, Gerhard Hindricks
    Abstract:

    Aims To compare the acute and the 6 month outcome of Catheter ablation of atrial fibrillation (AF) using irrigated tip magnetic Catheter and remote magnetic cathter Navigation (RMN) with manual Catheter Navigation (MCN) in patients with paroxysmal and persistent AF. Methods and results In this retrospective analysis 356 patients (235 male, mean age: 57.9 ± 10.9 years) with AF (70.5%, paroxysmal) who underwent Catheter ablation between August 2007 and May 2008 using either RMN ( n = 70, 46 male, mean age: 57.9 ± 10.1 years, 50% paroxysmal) or MCN ( n = 286, 189 male, mean age: 58.0 ± 13.9 years, 75.5% paroxysmal) were included. All patients completed an intensive follow-up strategy. Complete pulmonary vein isolation was achieved in 87.6 and 99.6% of patients in RMN and MCN groups, respectively ( P < 0.05). The procedure, fluoroscopy, and radiofrequency application times were 223 ± 44 vs. 166 ± 52 min ( P < 0.0001), 13.7 ± 7.8 vs. 34.5 ± 15.1 min ( P < 0.0001), and 75.4 ± 20.9 vs. 53.2 ± 21.4 min ( P < 0.0001) in RMN and MCN groups, respectively. Seven (10.0%) and 28 (9.8%) patients in RMN and MCN groups received antiarrhythmic medications during the follow-up ( P = 0.96). All the patients completed the 6 month follow-up. Freedom from AF at 6 months was achieved in 57.8 and 66.4% of the patients in RMN and MCN groups, respectively ( P = 0.196). In patients without previous AF Catheter ablation procedure the freedom from AF at 6 months were 68.2 and 60.5% in the MCN and RMN groups, respectively ( P = 0.36). Conclusion Catheter ablation using irrigated tip magnetic Catheter and RMN is an effective and safe method for Catheter ablation of AF. Compared to manual Catheter Navigation, the procedure and radiofrequency application times were longer and fluoroscopy time was shorter in the RMN group compared with the MCN group.

  • Catheter ablation of scar related ventricular tachycardia in patients with electrical storm using remote magnetic Catheter Navigation
    Pacing and Clinical Electrophysiology, 2010
    Co-Authors: Arash Arya, Thomas Gaspar, Christopher Piorkowski, Charlotte Eitel, Phillip Sommer, Andreas Bollmann, Ulrike Wetzel, Daniela Husser, Gerhard Hindricks
    Abstract:

    Background: A remote magnetic Navigation system (MNS) has been used for ablation of ventricular arrhythmias. However, irrigated tip Catheter has not been evaluated in large series of patients. Objective: To evaluate acute and long-term efficiency of the newly available irrigated tip magnetic Catheter for radiofrequency (RF) ablation of scar-related ventricular tachycardia (VT) in patients with ischemic heart disease. Methods: Between January 2008 and October 2009, a total of 30 consecutive patients with ischemic heart disease (26 men, age 70.1 ± 8.7 years, left ventricular ejection fraction: 30 ± 9%) and electrical storm due to monomorphic VT underwent RF ablation using a remote MNS and a magnetic irrigated tip Catheter. Results: Acute success was defined as noninducibility of any monomorphic VT during programmed right and left ventricular stimulation, and obtained in 24 (80%) patients. A total of 1–6 VTs (mean 2.3 ± 1.2, 394 ± 108 ms, 210–660 ms) were inducible during each procedure. The duration of RF energy application was 41.2 ± 23.3 minutes, with total procedure and fluoroscopy times of 158 ± 47 minutes and 9.8 ± 5.3 minutes, respectively. No acute complications were observed during the procedures. During mean follow-up of 7.8 months, 21 patients (70%) had no recurrence of VT and received no implantable cardioverter defibrillator therapy. Among patients who were noninducible during programmed right ventricular stimulation (n = 25), ≥1 monomorphic VT was inducible during programmed left ventricular stimulation in four (16%) that was ablated successfully in three of them. Conclusions: Irrigated ablation of scar-related VT using remote MNS is an effective modality for management of the monomorphic VT in patients with ischemic cardiomyopathy with minimal radiation exposure. Programmed left (in addition to right) ventricular stimulation might be necessary to assess acute outcome of the ablation procedure. (PACE 2010; 1312–1318)

  • long term results and the predictors of outcome of Catheter ablation of atrial fibrillation using steerable sheath Catheter Navigation after single procedure in 674 patients
    Europace, 2010
    Co-Authors: Arash Arya, Gerhard Hindricks, Thomas Gaspar, Philipp Sommer, Andreas Bollmann, Daniela Husser, Kerstin Bode, Hans Kottkamp, Christopher Piorkowski
    Abstract:

    AIMS: Identifying suitable candidates for circumferential left atrial pulmonary vein ablation (CPVA). CPVA is widely used as an ablation strategy in patients with atrial fibrillation (AF). Understanding the predictors of long-term success of single Catheter ablation procedure of AF based on CPVA can help to identify those patients who have a high risk of recurrence based on this approach. METHODS AND RESULTS: In this retrospective analysis 674 consecutive patients (464 male, mean age 57.3 +/- 10.8 years) with AF (84.8%, paroxysmal) treated with CPVA ablation between May 2005 and August 2007 using a manually controlled steerable sheath (Agilis((R)) St. Jude Medical Inc., St. Paul, MN, USA), were included. The endpoint of the ablation was the completion of predefined lesions (CPVA for paroxysmal, and CPVA+mitral isthmus and roof line ablation for persistent AF). Seven day Holter recordings were done immediately, 3, 6, and 12 month after ablation. AF longer than 30 s was considered as recurrence. The success was defined as lack of recurrence during 7-day Holter recordings done 3, 6, and 12 months after ablation. Early recurrence was defined as recurrence during the first 7-day Holter recording immediately after ablation. Forty-five and 20.8% of the patients received antiarrhythmic medications for the first 3 and 6 months after ablation procedure, respectively. After 6 months all antiarrhythmics were discontinued. About 51.5% experienced early recurrence. Twelve months success rate was 75.7% (paroxysmal: 75.7%, persistent: 75.0%, P = 1.0). Using multivariate analysis left atrial (LA) diameter > or =50 mm was the predictor of early recurrence {Hazard Ratio (HR) [95% confidence interval (CI)] = 5.1 (2.0-12.9)}. LA Diameter > or =50 mm [HR (95% CI) = 4.6 (2.6-9.1)]; early recurrence [HR (95% CI) = 4.3 (2.0-9.1)]; and arterial hypertension [HR (95% CI) = 4.6 (2.6-9.1)] were predictors of late recurrence. CONCLUSION: In our patients' cohort, a single Catheter ablation procedure based on CPVA using steerable sheath for Catheter Navigation resulted in a 1 year success rate of 75.7% [without (91.0%) and with (58.6%) early recurrence, respectively, P = 0.0001]. Among those patients who are at high risk for recurrence after CPVA other ablation endpoints rather than completion of predefined lesions might be necessary to increase the success rate.

Stéphane Cotin - One of the best experts on this subject based on the ideXlab platform.

  • blood vessel modeling for interactive simulation of interventional neuroradiology procedures
    Medical Image Analysis, 2017
    Co-Authors: René Anxionnat, Erwan Kerrien, Ahmed Yureidini, Jeremie Dequidt, Christian Duriez, Stéphane Cotin
    Abstract:

    Endovascular interventions can benefit from interactive simulation in their training phase but also during pre-operative and intra-operative phases if simulation scenarios are based on patient data. A key feature in this context is the ability to extract, from patient images, models of blood vessels that impede neither the realism nor the performance of simulation. This paper addresses both the segmentation and reconstruction of the vasculature from 3D Rotational Angiography data, and adapted to simulation: An original tracking algorithm is proposed to segment the vessel tree while filtering points extracted at the vessel surface in the vicinity of each point on the centerline; then an automatic procedure is described to reconstruct each local unstructured point set as a skeleton-based implicit surface (blobby model). The output of successively applying both algorithms is a new model of vasculature as a tree of local implicit models. The segmentation algorithm is compared with Multiple Hypothesis Testing (MHT) algorithm (Friman et al, 2010) on patient data, showing its greater ability to track blood vessels. The reconstruction algorithm is evaluated on both synthetic and patient data and demonstrates its ability to fit points with a subvoxel precision. Various tests are also reported where our model is used to simulate Catheter Navigation in interventional neuroradiology. An excellent realism, and much lower computational costs are reported when compared to triangular mesh surface models.

  • blood vessel modeling for interactive simulation of interventional neuroradiology procedures
    Medical Image Analysis, 2017
    Co-Authors: René Anxionnat, Erwan Kerrien, Ahmed Yureidini, Jeremie Dequidt, Christian Duriez, Stéphane Cotin
    Abstract:

    Endovascular interventions can benefit from interactive simulation in their training phase but also during pre-operative and intra-operative phases if simulation scenarios are based on patient data. A key feature in this context is the ability to extract, from patient images, models of blood vessels that impede neither the realism nor the performance of simulation. This paper addresses both the segmentation and reconstruction of the vasculature from 3D Rotational Angiography data, and adapted to simulation: An original tracking algorithm is proposed to segment the vessel tree while filtering points extracted at the vessel surface in the vicinity of each point on the centerline; then an automatic procedure is described to reconstruct each local unstructured point set as a skeleton-based implicit surface (blobby model). The output of successively applying both algorithms is a new model of vasculature as a tree of local implicit models. The segmentation algorithm is compared with Multiple Hypothesis Testing (MHT) algorithm (Friman et al, 2010) on patient data, showing its greater ability to track blood vessels. The reconstruction algorithm is evaluated on both synthetic and patient data and demonstrates its ability to fit points with a subvoxel precision. Various tests are also reported where our model is used to simulate Catheter Navigation in interventional neuroradiology. An excellent realism, and much lower computational costs are reported when compared to triangular mesh surface models.

  • new approaches to Catheter Navigation for interventional radiology simulation
    Computer Aided Surgery, 2006
    Co-Authors: Christian Duriez, Stéphane Cotin, Julien Lenoir, Paul E Neumann
    Abstract:

    For over 20 years, interventional methods have improved the outcomes of patients with cardiovascular disease. However, these procedures require an intricate combination of visual and tactile feedback and extensive training. In this paper, we describe a series of novel approaches that have led to the development of a high-fidelity simulation system for interventional neuroradiology. In particular, we focus on a new approach for real-time deformation of devices such as Catheters and guidewires during Navigation inside complex vascular networks. This approach combines a real-time incremental Finite Element Model (FEM), an optimization strategy based on substructure decomposition, and a new method for handling collision response in situations where the number of contact points is very large. We also briefly describe other aspects of the simulation system, from patient-specific segmentation to the simulation of contrast agent propagation and fast volume-rendering techniques for generating synthetic X-ray images in real time. Although currently targeted at stroke therapy, our results are applicable to the simulation of any interventional radiology procedure.

  • new approaches to Catheter Navigation for interventional radiology simulation
    Medical Image Computing and Computer-Assisted Intervention, 2005
    Co-Authors: Stéphane Cotin, Christian Duriez, Julien Lenoir, Paul F Neumann, S Dawson
    Abstract:

    For over 20 years, interventional methods have improved the outcomes of patients with cardiovascular disease. However, these procedures require an intricate combination of visual and tactile feedback and extensive training periods. In this paper, we describe a series of novel approaches that have lead to the development of a high-fidelity simulation system for interventional neuroradiology. In particular we focus on a new approach for real-time deformation of devices such as Catheters and guidewires during Navigation inside complex vascular networks. This approach combines a real-time incremental Finite Element Model, an optimization strategy based on substructure decomposition, and a new method for handling collision response in situations where the number of contacts points is very large. We also briefly describe other aspects of the simulation system, from patient-specific segmentation to the simulation of contrast agent propagation and fast volume rendering techniques for generating synthetic X-ray images in real-time.

Erwan Kerrien - One of the best experts on this subject based on the ideXlab platform.

  • blood vessel modeling for interactive simulation of interventional neuroradiology procedures
    Medical Image Analysis, 2017
    Co-Authors: René Anxionnat, Erwan Kerrien, Ahmed Yureidini, Jeremie Dequidt, Christian Duriez, Stéphane Cotin
    Abstract:

    Endovascular interventions can benefit from interactive simulation in their training phase but also during pre-operative and intra-operative phases if simulation scenarios are based on patient data. A key feature in this context is the ability to extract, from patient images, models of blood vessels that impede neither the realism nor the performance of simulation. This paper addresses both the segmentation and reconstruction of the vasculature from 3D Rotational Angiography data, and adapted to simulation: An original tracking algorithm is proposed to segment the vessel tree while filtering points extracted at the vessel surface in the vicinity of each point on the centerline; then an automatic procedure is described to reconstruct each local unstructured point set as a skeleton-based implicit surface (blobby model). The output of successively applying both algorithms is a new model of vasculature as a tree of local implicit models. The segmentation algorithm is compared with Multiple Hypothesis Testing (MHT) algorithm (Friman et al, 2010) on patient data, showing its greater ability to track blood vessels. The reconstruction algorithm is evaluated on both synthetic and patient data and demonstrates its ability to fit points with a subvoxel precision. Various tests are also reported where our model is used to simulate Catheter Navigation in interventional neuroradiology. An excellent realism, and much lower computational costs are reported when compared to triangular mesh surface models.

  • blood vessel modeling for interactive simulation of interventional neuroradiology procedures
    Medical Image Analysis, 2017
    Co-Authors: René Anxionnat, Erwan Kerrien, Ahmed Yureidini, Jeremie Dequidt, Christian Duriez, Stéphane Cotin
    Abstract:

    Endovascular interventions can benefit from interactive simulation in their training phase but also during pre-operative and intra-operative phases if simulation scenarios are based on patient data. A key feature in this context is the ability to extract, from patient images, models of blood vessels that impede neither the realism nor the performance of simulation. This paper addresses both the segmentation and reconstruction of the vasculature from 3D Rotational Angiography data, and adapted to simulation: An original tracking algorithm is proposed to segment the vessel tree while filtering points extracted at the vessel surface in the vicinity of each point on the centerline; then an automatic procedure is described to reconstruct each local unstructured point set as a skeleton-based implicit surface (blobby model). The output of successively applying both algorithms is a new model of vasculature as a tree of local implicit models. The segmentation algorithm is compared with Multiple Hypothesis Testing (MHT) algorithm (Friman et al, 2010) on patient data, showing its greater ability to track blood vessels. The reconstruction algorithm is evaluated on both synthetic and patient data and demonstrates its ability to fit points with a subvoxel precision. Various tests are also reported where our model is used to simulate Catheter Navigation in interventional neuroradiology. An excellent realism, and much lower computational costs are reported when compared to triangular mesh surface models.

Arash Arya - One of the best experts on this subject based on the ideXlab platform.

  • efficacy and safety of remote magnetic Catheter Navigation vs manual steerable sheath guided ablation for Catheter ablation of atrial fibrillation a case control study
    Europace, 2015
    Co-Authors: Emmanuel Koutalas, Gerhard Hindricks, Sascha Rolf, Phillip Sommer, Andreas Bollmann, Sergio Richter, Livio Bertagnolli, Ole A Breithardt, Arash Arya
    Abstract:

    Aims Data comparing remote magnetic Catheter Navigation (RMN) to manual Catheter Navigation (MCN) using steerable sheath for ablation of atrial fibrillation (AF) is lacking. The aim of the present case–control study was to seek AF recurrence data after AF ablation using RMN in comparison to MCN using steerable sheath in patients with either paroxysmal or persistent AF. Methods and results This study comprised 140 patients with AF (50% paroxysmal). Seventy were ablated utilizing RMN and 70 with MCN. Primary endpoint was defined as the time to first recurrence after index procedure. After 28.8 ± 18.9 months of follow-up, more patients in the MCN group using steerable sheath remained free of recurrence compared with RMN group [(59.1 vs. 40%, respectively, P = 0.031), in patients with persistent AF P = 0.057, while in patients with paroxysmal AF, P = 0.18]. Index procedure time (223.6 ± 44.2 vs. 170.8 ± 51.8 min, P < 0.001) and radiofrequency application time (75.4 ± 20.9 vs. 56.6 ± 24.9 min, P < 0.001) were longer in the RMN group; however, the respective total fluoroscopy time (13.7 ± 7.8 vs. 36.6 ± 12.7 min, P < 0.001) was significantly shorter. In multivariable Cox-regression analysis, RMN was the only factor independently associated with shorter time to first recurrence during follow-up ( P = 0.048). Complication rate did not differ significantly between groups ( P = 0.056), although the incidence of significant pericardial effusion was higher in the MCN group (3 cases vs. 0 in RMN group). Conclusion Although in patients with persistent AF, the recurrence rate is higher in RMN group, the outcome is comparable between RMN and MCN groups in patients with paroxysmal AF. A multicentre prospective randomized study is warranted to clarify this issue.

  • initial experience in ablation of typical atrial flutter using a novel three dimensional Catheter tracking system
    Europace, 2013
    Co-Authors: Philipp Sommer, Gerhard Hindricks, Thomas Gaspar, Charlotte Eitel, Agnieszka Wojdylahordynska, Sascha Rolf, Arash Arya, Christopher Piorkowski
    Abstract:

    Aims Three-dimensional (3D) mapping has been established for clinical routine in an interventional electrophysiology (EP). Recently, a novel sensor-based 3D Catheter tracking system has been introduced integrating 3D non-fluoroscopic Catheter Navigation into the environment of pre-recorded 2D fluoroscopy [MediGuide™ Technology (MG)]. We are reporting on the first clinical experience for ablation of typical atrial flutter. First we aimed to demonstrate safety and feasibility of this new technique. Secondly, procedural aspects such as effectiveness, procedure, and fluoroscopy time should be evaluated. Methods and results Ten consecutive patients (100% male, age 68 ± 8 years) were ablated using MG technology. Two steerable diagnostic EP Catheters (MediGuide Enabled Livewire™ Catheter, SJM) were used for coronary sinus cannulation and anatomical cavo-tricuspidal isthmus (CTI) reconstruction within the EnSite NavX™ System (NavX). Ablation was performed with a conventional 8 mm tip ablation Catheter (IBI, SJM). In all 10 patients both sensor-equipped MG Catheters could be tracked non-fluoroscopically. Successful anatomical CTI reconstruction was performed and complete isthmus block was documented after the ablation. Total procedure duration was comparable with conventional procedures (55 ± 8 min). Usage of the MG tracking system resulted in a fluoroscopy time of 2.5 ± 2 min. No adverse events occurred during the procedures. Conclusions For the first clinical application of the MG technology in an interventional electrophysiology we found a stable system enabling excellent 3D orientation for spatial Catheter positioning on the basis of underlying pre-recorded cine loops. Clinically, the MG technology allowed successful procedures with short fluoroscopy times, even though a sensor-equipped ablation Catheter was not yet available for use in the study.

  • Catheter ablation of atrial fibrillation using remote magnetic Catheter Navigation a case control study
    Europace, 2011
    Co-Authors: Arash Arya, Thomas Gaspar, Christopher Piorkowski, Ruzbeh Zakershahrak, Phillip Sommer, Andreas Bollmann, Ulrike Wetzel, Sergio Richter, Daniela Husser, Gerhard Hindricks
    Abstract:

    Aims To compare the acute and the 6 month outcome of Catheter ablation of atrial fibrillation (AF) using irrigated tip magnetic Catheter and remote magnetic cathter Navigation (RMN) with manual Catheter Navigation (MCN) in patients with paroxysmal and persistent AF. Methods and results In this retrospective analysis 356 patients (235 male, mean age: 57.9 ± 10.9 years) with AF (70.5%, paroxysmal) who underwent Catheter ablation between August 2007 and May 2008 using either RMN ( n = 70, 46 male, mean age: 57.9 ± 10.1 years, 50% paroxysmal) or MCN ( n = 286, 189 male, mean age: 58.0 ± 13.9 years, 75.5% paroxysmal) were included. All patients completed an intensive follow-up strategy. Complete pulmonary vein isolation was achieved in 87.6 and 99.6% of patients in RMN and MCN groups, respectively ( P < 0.05). The procedure, fluoroscopy, and radiofrequency application times were 223 ± 44 vs. 166 ± 52 min ( P < 0.0001), 13.7 ± 7.8 vs. 34.5 ± 15.1 min ( P < 0.0001), and 75.4 ± 20.9 vs. 53.2 ± 21.4 min ( P < 0.0001) in RMN and MCN groups, respectively. Seven (10.0%) and 28 (9.8%) patients in RMN and MCN groups received antiarrhythmic medications during the follow-up ( P = 0.96). All the patients completed the 6 month follow-up. Freedom from AF at 6 months was achieved in 57.8 and 66.4% of the patients in RMN and MCN groups, respectively ( P = 0.196). In patients without previous AF Catheter ablation procedure the freedom from AF at 6 months were 68.2 and 60.5% in the MCN and RMN groups, respectively ( P = 0.36). Conclusion Catheter ablation using irrigated tip magnetic Catheter and RMN is an effective and safe method for Catheter ablation of AF. Compared to manual Catheter Navigation, the procedure and radiofrequency application times were longer and fluoroscopy time was shorter in the RMN group compared with the MCN group.

  • Catheter ablation of scar related ventricular tachycardia in patients with electrical storm using remote magnetic Catheter Navigation
    Pacing and Clinical Electrophysiology, 2010
    Co-Authors: Arash Arya, Thomas Gaspar, Christopher Piorkowski, Charlotte Eitel, Phillip Sommer, Andreas Bollmann, Ulrike Wetzel, Daniela Husser, Gerhard Hindricks
    Abstract:

    Background: A remote magnetic Navigation system (MNS) has been used for ablation of ventricular arrhythmias. However, irrigated tip Catheter has not been evaluated in large series of patients. Objective: To evaluate acute and long-term efficiency of the newly available irrigated tip magnetic Catheter for radiofrequency (RF) ablation of scar-related ventricular tachycardia (VT) in patients with ischemic heart disease. Methods: Between January 2008 and October 2009, a total of 30 consecutive patients with ischemic heart disease (26 men, age 70.1 ± 8.7 years, left ventricular ejection fraction: 30 ± 9%) and electrical storm due to monomorphic VT underwent RF ablation using a remote MNS and a magnetic irrigated tip Catheter. Results: Acute success was defined as noninducibility of any monomorphic VT during programmed right and left ventricular stimulation, and obtained in 24 (80%) patients. A total of 1–6 VTs (mean 2.3 ± 1.2, 394 ± 108 ms, 210–660 ms) were inducible during each procedure. The duration of RF energy application was 41.2 ± 23.3 minutes, with total procedure and fluoroscopy times of 158 ± 47 minutes and 9.8 ± 5.3 minutes, respectively. No acute complications were observed during the procedures. During mean follow-up of 7.8 months, 21 patients (70%) had no recurrence of VT and received no implantable cardioverter defibrillator therapy. Among patients who were noninducible during programmed right ventricular stimulation (n = 25), ≥1 monomorphic VT was inducible during programmed left ventricular stimulation in four (16%) that was ablated successfully in three of them. Conclusions: Irrigated ablation of scar-related VT using remote MNS is an effective modality for management of the monomorphic VT in patients with ischemic cardiomyopathy with minimal radiation exposure. Programmed left (in addition to right) ventricular stimulation might be necessary to assess acute outcome of the ablation procedure. (PACE 2010; 1312–1318)

  • long term results and the predictors of outcome of Catheter ablation of atrial fibrillation using steerable sheath Catheter Navigation after single procedure in 674 patients
    Europace, 2010
    Co-Authors: Arash Arya, Gerhard Hindricks, Thomas Gaspar, Philipp Sommer, Andreas Bollmann, Daniela Husser, Kerstin Bode, Hans Kottkamp, Christopher Piorkowski
    Abstract:

    AIMS: Identifying suitable candidates for circumferential left atrial pulmonary vein ablation (CPVA). CPVA is widely used as an ablation strategy in patients with atrial fibrillation (AF). Understanding the predictors of long-term success of single Catheter ablation procedure of AF based on CPVA can help to identify those patients who have a high risk of recurrence based on this approach. METHODS AND RESULTS: In this retrospective analysis 674 consecutive patients (464 male, mean age 57.3 +/- 10.8 years) with AF (84.8%, paroxysmal) treated with CPVA ablation between May 2005 and August 2007 using a manually controlled steerable sheath (Agilis((R)) St. Jude Medical Inc., St. Paul, MN, USA), were included. The endpoint of the ablation was the completion of predefined lesions (CPVA for paroxysmal, and CPVA+mitral isthmus and roof line ablation for persistent AF). Seven day Holter recordings were done immediately, 3, 6, and 12 month after ablation. AF longer than 30 s was considered as recurrence. The success was defined as lack of recurrence during 7-day Holter recordings done 3, 6, and 12 months after ablation. Early recurrence was defined as recurrence during the first 7-day Holter recording immediately after ablation. Forty-five and 20.8% of the patients received antiarrhythmic medications for the first 3 and 6 months after ablation procedure, respectively. After 6 months all antiarrhythmics were discontinued. About 51.5% experienced early recurrence. Twelve months success rate was 75.7% (paroxysmal: 75.7%, persistent: 75.0%, P = 1.0). Using multivariate analysis left atrial (LA) diameter > or =50 mm was the predictor of early recurrence {Hazard Ratio (HR) [95% confidence interval (CI)] = 5.1 (2.0-12.9)}. LA Diameter > or =50 mm [HR (95% CI) = 4.6 (2.6-9.1)]; early recurrence [HR (95% CI) = 4.3 (2.0-9.1)]; and arterial hypertension [HR (95% CI) = 4.6 (2.6-9.1)] were predictors of late recurrence. CONCLUSION: In our patients' cohort, a single Catheter ablation procedure based on CPVA using steerable sheath for Catheter Navigation resulted in a 1 year success rate of 75.7% [without (91.0%) and with (58.6%) early recurrence, respectively, P = 0.0001]. Among those patients who are at high risk for recurrence after CPVA other ablation endpoints rather than completion of predefined lesions might be necessary to increase the success rate.