Imaging Based Analysis of Patients with Atrial Fibrillation Rob - - PDF document

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Imaging Based Analysis of Patients with Atrial Fibrillation Rob - - PDF document

Nov 04, 2023 141 likes •378 views

Imaging Based Analysis of Patients with Atrial Fibrillation Rob MacLeod, University of Utah CARMA Center, SCI Institute, CVRTI Bioengineering Department !"#$%&'&()*+&,-%%./'#*-

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Imaging Based Analysis

  • f Patients with Atrial

Fibrillation

Rob MacLeod, University of Utah CARMA Center, SCI Institute, CVRTI Bioengineering Department

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CARMA

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What is Atrial Fibrillation? = Afib = AF

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Normal Contraction Atrial Fibrillation

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Miyasaka et al. Circulation. 2006;114:119-125.

2 4 6 8 10 12 14 16 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

5.1 5.1 5.6 5.9 6.7 6.1 6.8 7.7 8.9 7.5 8.4 10.2 9.4 11.7 13.1 10.3 11.1 14.3 15.2 15.9 11.7 12.1

Projected Number of Persons With AF (millions) Year Current age-adjusted AF incidence Increased age-adjusted AF incidence

AF Prevalence

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We All Get Older

3.0 6.0 9.0 12.0 <55 55-59 60-64 65-69 70-74 75-79 80-84 >85 11.1 10.3 7.3 5.0 3.0 1.7 0.9 0.2 9.1 7.2 5.0 3.4 1.7 1.0 0.4 0.1

Prevalence (%)

Age (years) Women (n=7,801) Men (n=10,173)

Go AS, et al. JAMA. 2001;285:2370-2375.
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So What?

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20% of Strokes

$20 billion/year

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What Causes AFib?

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Substrate Trigger +

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Subsrate:Fibrosis

Lee KW, et al. Circ. 2006: 1703-1712.

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Complex Propagation

de Groot, .... Allessie MA. Circ. 2010: 1674-1682.

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LAA PV PV LA

Substrate: Extension of muscle sleeves

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*

Pulmonary Veins

Left Atrium

Triggers

* * *

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Clinical Result

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Clinical Result

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Treatment?

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Catheter Ablation

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Imaging in AF

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Ultrasound Fluoroscopy

Imaging Modalities in AF

MR Angiography Electroanatomical

Real time MRI

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Electroanatomical Mapping

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MR Angiography

Pre First Pass Subtraction

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Late Gadolinium Enhancement

Pre-treatment 3 month Post

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Evaluation

Patient Workflow

Treatment Followup

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Fibrosis and Outcome

Pseudo-color

Normal Low-voltage Enhanced (fibrosis?)

Pseudo-color

Normal Low-voltage Enhanced (fibrosis?)

Electroanatomical Map Electroanatomical Map

Evaluation

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Utah Scoring Scheme

Evaluation

Akoum et al. J Cardiovasc Electrophysiol, 22:16-22, 2011

< 5% 5-20% 20-35% > 35%

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Fibrosis Image Analysis Evaluation

Pixel Intensity Frequency

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Past Workflow

Evaluation

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Corview

Evaluation

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Evaluation

Patient Workflow

Treatment Followup

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Ablation Guidance

Treatment

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MRI Guided Ablation

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Real Time MRI

March, 2011

Treatment

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Segmentation for Guidance

Treatment

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Electroanatomical Mapping

Treatment

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Evaluation

Patient Workflow

Treatment Followup

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EAM vs. MRI

Followup

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Tracking Ablation

LGE (pre) LGE (<1 hr) LGE (3 mo)

Followup

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Repeat Ablation

Incomplete Isolation

Complete Isolation

Patient 1

First PVAI - Posterior Left Second PVAI - Posterior Left

Incomplete Isolation Complete Isolation

Patient 2

First PVAI - Posterior Left Second PVAI - Posterior Left

McGann et al. JACC,52(15): 1263-1272, 2008

Followup

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Evaluation

Open Challenges

Treatment Followup

Image quality Signal Acq./Proc. LA Segmentation Fibrosis Detection Scar Detection Lesion Imaging Case Simulation

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Clinical Impact