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

Imaging Based Analysis of Patients with Atrial Fibrillation Rob MacLeod, University of Utah CARMA Center, SCI Institute, CVRTI Bioengineering Department !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

!"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% CARMA !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

What is Atrial Fibrillation? = Afib = AF !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Normal Contraction Atrial Fibrillation !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

AF Prevalence 15.9 15.2 16 14.3 13.1 14 Projected Number of Persons 11.7 12 10.2 12.1 With AF (millions) 11.7 10 8.9 11.1 7.7 10.3 8 9.4 6.7 8.4 5.9 7.5 6 5.1 6.8 6.1 Current age-adjusted AF incidence 5.6 5.1 4 Increased age-adjusted AF incidence 2 0 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 Year Miyasaka et al. Circulation . 2006;114:119-125. !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% We All Get Older Women (n=7,801) Men (n=10,173) 12.0 11.1 10.3 9.1 9.0 Prevalence (%) 7.3 7.2 6.0 5.0 5.0 3.4 3.0 3.0 1.7 1.7 1.0 0.9 0.4 0.2 0.1 0 <55 55-59 60-64 65-69 70-74 75-79 80-84 >85 Age (years) Go AS, et al. JAMA . 2001;285:2370-2375. !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

So What? !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% 20% of Strokes $20 billion/year !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

What Causes AFib? !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Substrate + Trigger !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Subsrate:Fibrosis Lee KW, et al. Circ. 2006: 1703-1712. !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Complex Propagation de Groot, .... Allessie MA. Circ. 2010: 1674-1682. !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Substrate: Extension of muscle sleeves LAA LA PV PV !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Triggers Left Atrium * * * * Pulmonary Veins !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Clinical Result !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Clinical Result !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Treatment? !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Catheter Ablation !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Imaging in AF !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Imaging Modalities in AF Fluoroscopy MR Angiography Electroanatomical Ultrasound Real time MRI !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Electroanatomical Mapping !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% MR Angiography Subtraction Pre First Pass !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Late Gadolinium Enhancement Pre-treatment 3 month Post !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Patient Workflow Evaluation Treatment Followup !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Fibrosis and Outcome Evaluation Pseudo-color Electroanatomical Map Enhanced Low-voltage (fibrosis?) Normal Pseudo-color Electroanatomical Map Enhanced Low-voltage (fibrosis?) Normal !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Utah Scoring Scheme Evaluation < 5% 5-20% 20-35% > 35% Akoum et al. J Cardiovasc Electrophysiol, 22:16-22, 2011 !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Fibrosis Image Analysis Evaluation Frequency Pixel Intensity !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Past Workflow Evaluation !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Corview Evaluation !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Patient Workflow Evaluation Treatment Followup !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Ablation Guidance Treatment !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% MRI Guided Ablation !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Treatment Real Time MRI March, 2011 !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Segmentation for Treatment Guidance !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Electroanatomical Treatment Mapping !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Patient Workflow Evaluation Treatment Followup !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Followup EAM vs. MRI !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Followup Tracking Ablation LGE (pre) LGE (<1 hr) LGE (3 mo) !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Followup Repeat Ablation Patient 1 Patient 2 Incomplete Isolation Incomplete Isolation First PVAI - Posterior Left First PVAI - Posterior Left Complete Isolation Complete Isolation Second PVAI - Posterior Left Second PVAI - Posterior Left McGann et al. JACC,52(15): 1263-1272, 2008 !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&% Open Challenges Evaluation Treatment Followup Image quality Signal Acq./Proc. LA Segmentation Fibrosis Detection Scar Detection Lesion Imaging Case Simulation !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%

Clinical Impact !"#$%&'&()*+&,-%%./'#*- %&)&-%!',0,#-(-1&#&(/,!&(/&%