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Cardiac Anatomy at APHRS2018

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There is an increasing importance of cardiac anatomy for us to understand the mechanism of arrhythmia and to develop the treatment strategy of patients with abnormal cardiac rhythm. Before the era of active intervention on cardiac arrhythmia, arrhythmia was a domain for physiologists and medical therapist. Now we have achieved a tremendous development in electro-anatomical mapping technologies to show the conduction sequences within the cardiac wall. The mapping systems are based on a non-fluoroscopic visualization of mapping catheters and a 3D reconstruction created by the manipulation of a mapping catheter. Electrical information at map points is recorded and used for the color-coded display of the electrical activation sequence known as “activation mapping”, the display of post-pacing intervals known as “entrainment mapping” or the display of unipolar/bipolar electrograms as part of “fractionation” or “voltage mapping”.

 

These mapping technologies are used in most centers for arrhythmia and the most benefited example is the atrial fibrillation. The atrial fibrillation is treated by the pulmonary vein isolation through electro-anatomical mapping and radiofrequency ablation.  Mapping technology makes beautiful pictures based on electrical mapping and then treat the patient through RF ablation (Fig. 1). To achieve better result accurate mapping and ablation are important and the understanding on the anatomy is crucial basic knowledge for physicians. Anatomy of the real heart specimen (Fig. 2) explains much more than the information from the electroanatomical mapping, such as the thickness of the atrial wall at the particular site and the adjacent structure which may be damaged by the ablation procedure.  Digital technology can be further applied to make a 3 dimensional model of the same left atrium together with pulmonary veins based on the CT scanned data of a patient (Fig. 3).

 

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Fig. 1. Electro-anatomical mapping of the posterior aspect of the left atrium showing pulmonary veins draining to the left atrium. (Nedios S, Sommer P, Bollmann A, Hindricks G. Advanced Mapping Systems To Guide Atrial Fibrillation Ablation: Electrical Information That Matters. Journal of Atrial Fibrillation 2016;8:1337.)

 

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Fig. 2. Photographs of a real heart specimen (left) and a cavitary cast (right) seen from the back (Seo JW. The Architecture of the Left Atrial Wall. APHRS2017, Yokohama, Japan)

 

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Fig. 3. A 3 dimensional printed model of the left atrium together with pulmonary veins is displayed in APHRS2018 based on the CT scan data of a patient. The left atrium is seen from posterior.

 

APHRS (Asia Pacific Heart Rhythm Society) Scientific Session 2018 was held in Taipei on 17-20 October 2018. The APHRS is an annual conference from 2008 and the history and importance of the activity are well explained in the video.

 

The contribution of cardiac anatomy in the APHRS2018 program was represented by a "Cardiac Imaging and Anatomy" sessions. A total of ten sessions were organized and two of them were the live demonstration at the Anatomy Theater. In addition, real autopsy heart specimens are displayed as well as videos explaining these hearts. Heart specimen videos are a demonstration of cardiac anatomy by English (Dr. Jeong-Wook Seo) followed by Chinese explanation by Dr. Hsuan-Ming Tsao. We thank the Department of Anatomy at National Yang-Ming University for supplying human autopsied hearts and video-recording facilities at the university.

 

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Fig. 4. Live video lecture by Dr. S. Yen Ho at the Anatomy Theater on 18 October 2018.

 

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Fig. 5. External view of the Anatomy Theater. Five monitors displayed recorded video files on atrial and ventricular conduction system in autopsied hearts. These are recorded in English and Chinese by Dr. Jeong-Wook Seo and Dr. Hsuan-Ming Tsao.

 

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Fig. 6. Interior of the Anatomy Theater. Doctors watched the display of the recorded videos by Dr. Jeong-Wook Seo and Dr. Hsuan-Ming Tsao. Three dimensional model of hearts by Dr. Jeong-Wook Seo and augmented reality model of hearts by Dr. Wei-Chih Hu are also presented at the Anatomy Theater.

 

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Fig. 7. Prof. Shih-Ann Chen, the Congress president visited the Anatomy Theater and acknowledged our contribution.

 

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Fig. 8. An article in the newspaper of the Congress on 18 October 2018 explaining the Anatomy Theater.

 

 

Human heart anatomy sessions started from APHRS2016 in Seoul. Hsuan-Ming Tsao (Taiwan), Siew Yen Ho (UK), Osamu Igawa (Japan) and Jeong-Wook Seo (Korea) became a team to run the program. Live video sessions and on-site display of the human autopsied hearts could produce a solid understanding of the cardiac conduction system and the anatomy of the heart related to the intervention procedures.

 

 

 

Related articles:

 

Heart Museum in Taipei at APHRS

 

Anatomy theater by Dr. Osamu Igawa at APHRS2017 Yokohama Japan

 

APHRS2016 Heart Specimen Display Scenes overview (1)