Multi-detector row CT provided a valuable road map prior to radiofrequency catheter ablation, identifying additional pulmonary veins in 30% of patients and common ostia in up to 83%.
Observational (n=34)
No
Does multi-detector row CT accurately depict pulmonary vein anatomy and variations in patients with atrial fibrillation prior to radiofrequency catheter ablation?
Multi-detector row CT effectively maps pulmonary vein anatomy and identifies significant anatomical variations prior to radiofrequency catheter ablation for atrial fibrillation.
PURPOSE: To evaluate multi-detector row computed tomographic (CT) depiction of pulmonary veins to provide a road map for radiofrequency catheter ablation. MATERIALS AND METHODS: For patients, institutional review board (IRB) approval was not required, and consent was obtained for treatment. Control subjects were part of an IRB-approved research protocol at the institution, in which they had consented to participate. Multi-detector row CT was performed in 23 patients (17 men, six women; mean age, 48 years +/- 11 standard deviation) with atrial fibrillation who were admitted for isolation of pulmonary veins by means of radiofrequency catheter ablation. Pulmonary vein anatomy was evaluated, and diameters of pulmonary vein ostia were measured. To determine the shape of ostia, a venous ostium index was calculated for all veins by dividing anterior-posterior measurements by superior-inferior measurements. Results were compared with those in a control group of 11 patients (eight men, three women; mean age, 56 years +/- 11) without atrial fibrillation. Images were evaluated by two observers in consensus. RESULTS: Pulmonary veins additional to the four main veins were found in seven (30%) of 23 patients. Common ostia of left and right pulmonary veins were detected in 19 (83%) and nine (39%) patients, respectively. Early branching occurred more often with right than with left veins (19 83% vs three 13% cases, P <.05) in both patients and control subjects. Anterior-posterior diameter of ostia was 12.8 mm +/- 3.3 for left veins, 16.2 mm +/- 3.8 for right veins, and 18.8 mm +/- 7.7 and 28.7 mm +/- 5.1 for left and right common ostia, respectively. Ostia of right pulmonary veins were more round than were ostia of left pulmonary veins (venous ostium index in patients, 0.91 +/- 0.21 vs 0.75 +/- 0.17, P <.05; in control subjects, 0.93 +/- 0.12 vs 0.82 +/- 0.17, P <.05). The CT data were used to determine ablation strategy and guide catheters during radiofrequency ablation. CONCLUSION: Multi-detector row CT provides a valuable road map for pulmonary vein anatomy prior to radiofrequency catheter ablation. Variations in number and insertion of pulmonary veins were observed in a considerable number of patients and control subjects.
Jongbloed et al. (Tue,) conducted a observational in Atrial fibrillation (n=34). Multi-detector row CT vs. Control subjects without atrial fibrillation was evaluated on Pulmonary vein anatomy, diameters, and venous ostium index. Multi-detector row CT provided a valuable road map prior to radiofrequency catheter ablation, identifying additional pulmonary veins in 30% of patients and common ostia in up to 83%.
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