Sufficient pulmonary vein image quality of non-enhanced multi-detector row computed tomography for pulmonary vein isolation by catheter ablation

AIMS: We evaluated the quality of non-enhanced multi-detector row computed tomography (MDCT) images of the pulmonary vein (PV) and the clinical results of catheter ablation to isolate the PV for treatment of atrial fibrillation (AF) without the use of contrast medium in patients with chronic kidney disease (CKD). METHODS AND RESULTS: We compared PV images quantitatively and qualitatively between non-enhanced and enhanced images (n = 50). Procedural parameters and clinical outcomes were compared between catheter ablation for AF referring solely to non-enhanced MDCT in CKD patients (n = 20) and using enhanced MDCT images integrated with electroanatomic mapping in non-CKD patients (n = 30). In gross anatomy, complete agreement was obtained between non-enhanced and enhanced MDCT images. Bland-Altman plots and cumulative coefficient variation showed good agreement in PV diameter determination between non-enhanced and enhanced MDCT images. There were no statistically significant differences in procedural or fluoroscopic times between PV isolation only referring to non-enhanced MDCT images and that using enhanced MDCT images integrated with electroanatomic mapping. Similarly, the ablation success rate and AF-free status at 3 months after PV isolation did not differ between PV isolation referring only to non-enhanced MDCT images and that using an electroanatomic integration system. No complications occurred in PV isolation with or without enhanced MDCT. CONCLUSIONS: Non-enhanced MDCT provides adequate PV image quality both quantitatively and qualitatively. The present study suggests that catheter ablation referring solely to non-enhanced MDCT images for AF could be performed with clinically acceptable results. These findings warrant further studies involving a much larger number of patients to confirm the present results.