Incidental Cardiac Computed Tomography Findings in Patients Undergoing Atrial Fibrillation Catheter Ablation

BACKGROUND: Catheter ablation (CA) is an effective technique for the management of atrial fibrillation (AF). Cardiac computed tomography (CCT) is a non-invasive imaging modality that is used as a crucial part of planning before CA procedures which can detect other incidental findings and require further diagnostic investigations. OBJECTIVES: We sought to assess the prevalence and distribution of incidental CCT findings in patients with AF undergoing CA. METHODS: Retrospective analysis over a three-year period (2013-2016) of 218 patients undergoing CCT prior to AF CA. CCT findings were analyzed and incident clinically important findings were reported. RESULTS: Over the three-year period, 218 patients had undergone CCT. Of these, 28.8% showed clinically significant incidental findings in the chest and upper abdomen. Incidental findings included coronary artery disease (CAD), incomplete cor triatriatum, pericardial effusion, pleural effusion, pulmonary nodules, pulmonary infiltrates, pulmonary mass, thoracic aortic aneurysm, mediastinal nodes, abdominal mass, and liver nodules. CONCLUSIONS: CCT is a cornerstone investigation prior to AF CA and can show multiple incidental findings, thus potentially functioning as a screening method for the detection of other significant conditions. There is still a debate whether further workup is needed or not as most findings will eventually be benign and further investigations could mean financial burden and clinical risks to the patients. Further larger prospective studies are needed with long-term follow-up to determine whether incidental findings on CCT have an impact on the long-term outcomes of patients.