Fig. 2 ∣. Schematic summarizing the process of importing OPTIMA ablation targets into the clinical electroanatomic navigation system (i.e., CARTO™).

The starting point for this process is the set of outputs from the OPTIMA approach (i.e., ablation targets on bi-atrial volumetric mesh reconstructed from LGE-MRI). Red regions indicate ablation targets from analysis; yellow regions indicate connecting lines. Targets located in the LA are mapped via co-registration onto a geometric reconstruction of the LA endocardial surface extracted from the same patient’s MRA scan, which includes anatomical features needed for peri-procedural registration (e.g., prominent ridge between left PVs and lateral LA). Notably, the LA geometry from MRA is a surface mesh (i.e., a 2D manifold in 3D space) and not a volumetric mesh. Since RA segmentation from the MRA scan is not possible, we instead derive a surface mesh of the RA endocardium, including any ablation targets, from the LGE-MRI-based model. The RA surface mesh with ablation targets is then down-sampled since high-resolution meshes cannot be loaded into the clinical mapping system. Finally, the LA-MRA and down-sampled RA surface meshes with the OPTIMA ablation plan are aligned and scale-matched via affine transformation, resulting in a geometric model ready to be converted into a Visualization Toolkit (VTK) file suitable for importing into the CARTO™ system. PV: pulmonary vein; MRA: magnetic resonance angiography; LA/RA: left/right atria; LGE-MRI: late gadolinium enhancement magnetic resonance imaging.