Key result
Rotational angiography during adenosine asystole provides useful LA-PV anatomy in ~94% of patients.
Why the study?
Atrial fibrillation ablation requires detailed anatomic information about the left atrium and pulmonary veins, and new imaging tools are needed to improve procedural guidance.
Does intra-procedural rotational angiography during adenosine-induced asystole provide accurate anatomical information of the left atrium and pulmonary veins compared to CT in patients undergoing atrial fibrillation ablation?
Does intra-procedural rotational angiography during adenosine-induced asystole provide accurate anatomical information of the left atrium and pulmonary veins compared to CT in patients undergoing atrial fibrillation ablation?
Intra-procedural rotational angiography during adenosine-induced asystole provides accurate anatomical information of the left atrium and pulmonary veins, correlating excellently with CT.
Answers are grounded in this paper and cite their sources.
May offer on-table LA/PV imaging during ablation; leaves open validation versus standard modalities in prospective trials.
AIMS: Atrial fibrillation ablation is a complex procedure that requires detailed anatomic information about left atrium (LA) and pulmonary veins (PVs). The goal of this study was to test rotational angiography of the LA during adenosine-induced asystole as an imaging tool in patients undergoing atrial fibrillation ablation. METHODS AND RESULTS: Seventy patients with paroxysmal or persistent atrial fibrillation undergoing PV isolation were included. After transseptal puncture, adenosine (30 mg) was given intravenously, and during atrioventricular block, contrast medium was directly injected in the LA; a rotational angiography was performed (right anterior oblique 55 degrees to left anterior oblique 55 degrees). Rotational angiography images were assessed qualitatively in all patients and quantitatively in 45 patients in comparison with computed tomography (CT) images. The majority of rotational angiography imaging data (94%) were deemed at least 'useful' in delineating the LA-PV anatomy. The so-called 'ridge' between left superior PV and left atrial appendage was delineated in 90% of the patients. All accessory PVs were independently identified by rotational angiography and CT. A blinded quantitative comparison of PV ostial diameters showed an excellent correlation between rotational angiography and CT measurements (r > 0.90 for all PVs). No serious adverse effects occurred in association with adenosine. CONCLUSION: Intra-procedural contrast-enhanced rotational angiography of the LA-PV during adenosine-induced asystole is feasible and provides anatomical information of high diagnostic value for atrial fibrillation ablation.
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Kriatselis et al. (2008) studied Atrial fibrillation (n=70). Rotational angiography during adenosine-induced asystole vs. Computed tomography (CT) was evaluated on Qualitative assessment of LA-PV anatomy and quantitative comparison of PV ostial diameters with CT (r > 0.90). Rotational angiography during adenosine-induced asystole provided useful LA-PV anatomical delineation in 94% of patients and correlated excellently with CT measurements.
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