Jonathan M. Behar et al. JACEP 2017;3:

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Jonathan M. Behar et al. JACEP 2017;3:803-814 Image Panel of Workflow The first step involves the automated segmentation and manual adjustment of the epicardial and endocardial slices to generate a 3-dimensional (3D) mesh. Endocardial wall motion is tracked over the cardiac cycle to generate volume vs. time curves for the 16 segments. Following registration of the cine to late gadolinium enhancement sequences, areas of myocardial fibrosis are identified and both scar and dyssynchrony data are reviewed and targets selected. The 3D shell is then registered to the x-ray (XR) once the patient is on the catheter laboratory table using fiducial markers, which show up white (from the CMR sequences) and gray with a central dark dot (lead ball-bearing) from the x-ray. Vertical and horizontal translation using biplane fluoroscopy is used, in addition to rotation about the x, y, and z axes to line up the markers as demonstrated on the right hand panel. Following this process, the CMR-derived 3D model is registered to the XR system and every fluoroscopic cine demonstrates the epicardial and endocardial shell overlaid in the correct orientation. Jonathan M. Behar et al. JACEP 2017;3:803-814 2017 The Authors