CCTA mapping for electrophysiological procedures

Congress:

ECR 2016

Poster Number:

C-1969

Type:

Educational Exhibit

Keywords:

Computer Applications-Detection, diagnosis, CT-Angiography, CT, Cardiovascular system, Cardiac, Education and training

Authors:

P. ARGYRIOU¹, G. Petrocheilou², S. Velitsista³, G. ANYFANTAKIS¹, A. Manginas¹, C. Xenophon¹, G. Kanoupakis¹; ¹Athens/GR, ²Alimos, Athens/GR, ³Haidari-Athens/GR

DOI:

10.1594/ecr2016/C-1969

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-1969

Fig. 1: Three-dimensional models of left atrium and pulmonary veins. There is a large...

Fig. 2: Multiplanar reconstructions of normal pulmonary venous anatomy. Coronal image....

Fig. 3: Multiplanar reconstructions of normal pulmonary venous anatomy. Coronal image....

Fig. 4: Measurment of ostial diameters on multiplanar reformations of the LT IPV

Learning objectives

The purpose of our educational exhibit is to: show how to demonstrate and evaluate the left atrium (LA), the left atrial appendage and the pulmonary and coronary vessels anatomy before the electrophysiological procedures (EP).

Background

Atrial fibrillation (AF) is the most common cardiac rhythm disturbance and its major complication is the formation of atrial thrombi. It has been discovered that paroxysms of AF are initiated by foci of spontaneous activity originating from the pulmonary veins in 90% of patients, with almost half arising in the left superior pulmonary vein. In most individuals sleeves of the left atrial myocardium extend into the pulmonary veins for a distance of 1-16mm. These arrhythmogenic foci are an important cause of both paroxysmal and persistent...

Findings and procedure details

We retrospectively reviewed 148 coronary CTAs done in our institution during the last three years in order to study pulmonary veins’ and left atrium anatomy. 63 CTAs was performed in patients (65-80 years old) with atrial fibrillation who were admitted for electrophysiological procedures. Coronary CTA was performed on a 64-slice source CT using ECG gating and bolus tracking. Protocols of PVs and coronary arteries were used. There was not thrombosis in the left atrium or left atrial appendage. Variations and anomalies of PVs were examined....

Conclusion

Knowledge of anatomic variations in pulmonary veins anatomy is vital in planning the EP strategy. The radiologists must be familiar with the left atrial anatomy.

Personal information

References

Joan M. Lacomis, MD , William Wigginton, BS, RTR(CT) , Carl Fuhrman, MD , et al. Multi–Detector Row CT of the Left Atrium and Pulmonary Veins before Radio-frequency Catheter Ablation for Atrial Fibrillation. RadioGraphics 2003; 23:S35–S50. Paul Cronin, Michael B. Sneider, Ella A. Kazerooni et al. MDCT of the Left Atrium and Pulmonary Veins in Planning Radiofrequency Ablation for Atrial Fibrillation: A How-To Guide. AJR 2004;183:767–778 Monique R. M. Jongbloed, MD , Martijn S. Dirksen, MD, PhD , Jeroen J. Bax, MD, PhD et al....