Left atrial measurement during routine diagnostic work up prior to pulmonary vein isolation predicts the success of the ablation procedure: The role of LA-dimensions and LA-volume assessed by multidetector computed tomography

This poster was previously presented in German at the Deutscher Röntgenkongress 2012 (Hamburg)

Congress:

ECR 2013

Poster Number:

C-0035

Type:

Scientific Exhibit

Keywords:

Cardiac, Interventional vascular, Pulmonary vessels, CT, CT-Angiography, Ablation procedures, Contrast agent-intravenous, Education and training

Authors:

J. M. Sohns, W. Staab, D. Vollmann, L. Lüthje, P. Zwaka, M. Zabel, G. Hasenfuß, J. Lotz; Göttingen/DE

DOI:

10.1594/ecr2013/C-0035

DOI-Link:

https://dx.doi.org/10.1594/ecr2013/C-0035

Fig. 1: Left atrial (LA) volume evaluation by 64-MDCT. Panel A, B, and C demonstrate...

Fig. 2: Figure 2: (A) Freedom from any AT/AF recurrence after the initial procedure...

Fig. 3: Figure 3: Scatter plot and linear correlation between LA-diameter (TEE) and...

Purpose

Multidetector computed tomography (MDCT) is a frequently used imaging modality prior to pulmonary vein isolation (PVI) in order to plan and guide the procedure. MDCT permits accurate imaging of left atrial (LA) anatomy. This study aimed to identify whether LA-volume assessed by MDCT is related to the success of PVI using a magnetic catheter navigation (RMN) system.

Methods and Materials

102 patients with drug-refractory symptomatic atrial fibrillation (AF) (age 62±10; 56% men; 68 paroxysmal AF) referred for PVI, with a RMN system, were included. Prior to the procedure, all patients underwent 64-MDCT scan for assessment of LA and PV-anatomy, LA-thrombus evaluation, LA-volume estimation and electroanatomical mapping integration.

Results

After a mean follow-up of 355±128 days, clinical success was estimated after a 3-month blanking period. At the end of the follow-up period 65% of the patients maintained sinus rhythm after the index procedure and 83% after an additional PVI. The LA-diameter, LA-volume and type of AF were significantly independent predictors of AF recurrence. There was a significant correlation between the LA-diameter (echocardiography) and LA-volume (MDCT) (p-value <0.001, r = 0.7). MDCT was superior to echocardiography in predicting the success of PVI. The probability of...

Conclusion

MDCT aids planning and guiding PVI procedures. LA-volume assessed by MDCT is a predictor of AF recurrence after PVI. This study suggests to generally including the measurement of LA-volume into the pre-procedural evaluation of patients presenting for PVI.

References

Niinuma H, George RT, Arbab-Zadeh A, Lima JA, Henrikson CA. Imaging of pulmonary veins during catheter ablation for atrial fibrillation: the role of multi-slice computed tomography. Europace 2008;10 Suppl 3:iii14-21. Knecht S, Skali H, O’Neill MD, Wright M, Matsuo S, Chaudhry GM et al. Computed tomography-fluoroscopy overlay evaluation during catheter ablation of left atrial arrhythmia. Europace 2008;10:931–8. Abecasis J, Dourado R, Ferreira A, Saraiva C, Cavaco D, Santos KR et al. Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation...

Personal Information

Dr. med. Jan Martin Sohns, MD Department of Radiology Center of Radiology, Georg-August-University Götingen Robert-Koch-Str. 40, 37075 Göttingen, Germany eMail: [email protected] Phone: +49-551-398965, Fax: +49-57551-369606, Thanks toJ. Menke (PD Dr. med.)for support.