Clinical evaluation of respiratory motion compensation for anatomical roadmap guided cardiac electrophysiology procedures

X-ray fluoroscopically guided cardiac electrophysiological procedures are routinely carried out for diagnosis and treatment of cardiac arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of static 3-D roadmaps derived from preprocedural volumetric data can be used to add anatomical information. However, the registration between the 3-D roadmap and the 2-D X-ray image can be compromised by patient respiratory motion. Three methods were designed and evaluated to correct for respiratory motion using features in the 2-D X-ray images. The first method is based on tracking either the diaphragm or the heart border using the image intensity in a region of interest. The second method detects the tracheal bifurcation using the generalized Hough transform and a 3-D model derived from 3-D preoperative volumetric data. The third method is based on tracking the coronary sinus (CS) catheter. This method uses blob detection to find all possible catheter electrodes in the X-ray image. A cost function is applied to select one CS catheter from all catheter-like objects. All three methods were applied to X-ray images from 18 patients undergoing radiofrequency ablation for the treatment of atrial fibrillation. The 2-D target registration errors (TRE) at the pulmonary veins were calculated to validate the methods. A TRE of 1.6 mm ± 0.8 mm was achieved for the diaphragm tracking; 1.7 mm ± 0.9 mm for heart border tracking, 1.9 mm ± 1.0 mm for trachea tracking, and 1.8 mm ± 0.9 mm for CS catheter tracking. We present a comprehensive comparison between the techniques in terms of robustness, as computed by tracking errors, and accuracy, as computed by TRE using two independent approaches.