Rotational Angiography: Use of Intra-procedural Imaging to Guide AF Ablation

Atrial fibrillation (AF) ablation is facilitated by anatomical visualization of the left atrium (LA) and the pulmonary veins (PVs). Rotational angiography is a novel method for three-dimensional reconstruction of the LA and PVs during Catheter ablation of AF. Pre-procedural CT/MRI images provide visualization of those structures and facilitate the integration with the electroanatomic mapping systems. However, there is a time lag to the actual procedure. Temporal change of the size and anatomical structure of the heart chamber might happen between the time periods of CT/MRI scanning and ablation. Rotational angiography provides the most real-time image for ablation procedure. The principal advantages of the rotational angiography are the accuracy of the left atrial anatomy because it is obtained immediately prior to the procedure and does not affect by the volume status of the patients. In addition, the radiation exposure of the rotational angiography is less than that of the conventional CT scanning. The drawback of the rotational angiography is the additional bolus of contrast agent, which may not be indicated in the patients with renal dysfunction or heart failure. In addition, adjustment of the image is required if there is patient movement. Despite those limitations, this three-dimensional real-time image is still a promising new method with comparable quality to a CT scan and can aid the AF ablation procedure.