Enhanced 3D cardiac imaging from Philips

Real-time three-dimensional imaging of cardiac anatomy offers electrophysiologists an improved workflow with new equipment from Philips launched globally at the Boston Atrial Fibrillation Symposium 2013 last week.

EP Navigator provides 3D rotational angiography with real-time anatomical details of cardiac left atrium-pulmonary vein structures. Marcel De Groot is electrophysiology segment leader responsible for Philips interventional X-ray business in electrophysiology.

“The concept of 3D rotational imaging has been around for a while, but in the electrophysiology domain, difficulties in the workflow have limited its application. This is what we have simplified with the introduction of our new EP navigator 4,” he told eHealth Insider.

Around 1-2% of the global population suffers from atrial fibrillation, which comprises an irregular and often rapid heart beat. Patients experience reduced quality of life because they can do very little exercise. Electrophysiologists can treat atrial fibrillation with an ablation procedure as an alternative to medicine.

The new system is the product of an agreement between Philips and Biosense Webster, which integrates Philips Allura X-ray images with the CartoAlara Module of Biosense Webster’s Carto 3 Electroanatomical Mapping System.

The latter effectively works like a Ground Positioning System in the heart following the catheter as it moves inside it, enabling electrophysiologists conducting catheter ablation procedures to see anatomical detail and orientation more clearly.

To visualise the 3D structure, the physician inserts contrast medium and the system rotates around the patient. From this scan the 3D heart chamber can be reconstructed and combined with the X-ray image to provide an enhanced image.

Often during the catheter ablation procedure, fluoroscopy alone provides an insufficient level of detail, which is where the EP Navigator approach steps into the breach.

“This helps electrophysiologists guide the catheters through the left atrium,” said De Groot. “EP navigator creates a 3D image of the heart chamber providing an extra level of confidence for the physician.”

Also, according to De Groot, prior to EP Navigator, a physician previously had to look at two screens- the X-ray image, and the mapping image, but “with our new system [the Philips-Biosense Webster collaboration] we integrate the two systems into one. We do that work for them, simplifying interpretation of the images. The workflow is much simpler now.”

As a further benefit, by combining the two images, the physician requires a lower X-ray dose during the procedure, which benefits the patient. It also promises to help visualise larger, obese patients who limit the movement of X-ray around the body.

“The new workflow is simpler because we can reduce the angle of the rotation, and there is option to do the rotation from the patient’s side rather than the back which makes a big difference with a seated patient,” De Groot pointed out.