Low-Dose Electrocardiography Synchronized Nonenhanced Computed Tomography for Assessing Left Atrium and Pulmonary Veins Before Radiofrequency Catheter Ablation for Atrial Fibrillation

• Published in: The American journal of cardiology Vol. 108; no. 4; pp. 536 - 540
• Main Authors: Lee, Hye-Jeong, MD, PhD, Kim, Young Jin, MD, PhD, Hur, Jin, MD, PhD, Nam, Ji Eun, MD, Hong, Yoo Jin, MD, Kim, Hee Yeong, MD, Kim, Hua Sun, MD, Choe, Kyu Ok, MD, PhD, Choi, Byoung Wook, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.08.2011; Elsevier; Elsevier Limited
• Subjects: Atrial Fibrillation - therapy; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Catheter Ablation; Electrocardiography; Female; Heart; Heart Atria - diagnostic imaging; Humans; Male; Medical sciences; Middle Aged; Other treatments; Pulmonary Veins - diagnostic imaging; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Sensitivity and Specificity; Tomography; Tomography, X-Ray Computed; Treatment. General aspects; Tumors; Veins & arteries; Atrium; Radiodiagnosis; Arrhythmia; Low dose; Atrial fibrillation; Instrumentation therapy; Catheter; Thermal ablation; Cardiovascular disease; Left pulmonary vein; Radiofrequency; Excitability disorder; Electrodiagnosis; Heart disease; Electrocardiography; Medical imagery; Computerized axial tomography; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.03.081

Recently contrast-enhanced cardiac computed tomography (CT) was found to be useful for imaging the left atrium and pulmonary veins (PVs) before radiofrequency catheter ablation in patients with atrial fibrillation. However, the risks of contrast agent in patients with impaired renal function must be considered. We investigated the accuracy of low-dose electrocardiographically synchronized nonenhanced cardiac CT (NECT) for identifying PV anatomy. One hundred eight consecutive patients who underwent cardiac CT before radiofrequency catheter ablation of atrial fibrillation were included. Nonenhanced cardiac computed tomogram was retrospectively evaluated for each patient by 2 radiologists for the following PV anatomy: conventional pattern, conjoined ostium, and accessory PVs with number and location. Sensitivity and specificity for variations in PVs were calculated using contrast-enhanced cardiac computed tomogram as the reference standard. Detection rates for each variation were also calculated. Twenty-one right PV (RPV) variations and 11 left PV (LPV) variations were observed. NECT showed a high diagnostic performance in detecting variations in PVs for the 2 observers. For RPV variations overall sensitivity was 97.6% and specificity was 96.6%. For LPV variations overall sensitivity was 90.9% and specificity was 97.9%. Overall detection rates for variation between the 2 observers were 97.1% for accessory RPV from the right middle lobe, 100% for 4 ostia with accessory RPV from the right middle lobe and accessory RPV from the superior segment of the right lower lobe, 100% for accessory RPV from the superior segment of the right lower lobe, 88.9% for conjoined ostium of the LPV, and 100% for accessory LPV from the left lingular segment. In conclusion, variations in PV anatomy were detected with great accuracy by NECT.