Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation: a head-to-head comparison.
OBJECTIVE
The purpose of this study was to perform a head-to-head comparison between multislice computed tomography (MSCT) and intracardiac echocardiography (ICE).


BACKGROUND
Different imaging techniques have been used to visualize the pulmonary veins (PV) before radiofrequency ablation of atrial fibrillation.


METHODS
The PV and their atrial insertion were evaluated in 42 patients (35 men, 49 +/- 9 years) admitted for ablation of PV ostia. Ostia were measured in two directions (anterior-posterior and superior-inferior) with MSCT. Two-dimensional (2-D) measurements of PV ostia were performed with ICE. Results were compared, considering MSCT as the gold standard. Venous ostium indexes were calculated by dividing MSCT measurements in the anterior-posterior direction and the superior-inferior direction.


RESULTS
Common ostia of left PV were observed in 33 (79%) patients with MSCT and 31 (74%) patients with ICE. Common ostia of right PV were observed in 13 (31%) and 16 (38%) patients, respectively. Additional PV were observed in 13 (31%) patients with MSCT and in 7 (17%) patients with ICE. Ostial diameters by MSCT in the anterior-posterior direction were similar to 2-D measurements by ICE. By contrast, diameters by MSCT in the superior-inferior direction were significantly larger than 2-D diameters measured with ICE. Venous ostium indexes were 0.77 +/- 0.18 and 0.90 +/- 0.15 (p < 0.01) for left and right PV respectively, indicating an oval shape of particularly left PV ostia.


CONCLUSIONS
Variation in PV anatomy is frequently observed with both techniques. The sensitivity for detection of additional branches is higher for MSCT. Results of measurements of PV ostia suggest an underestimation of ostial size by ICE. Three-dimensional imaging techniques, such as MSCT, are required to demonstrate an oval shape of PV ostia.
Jongbloed
Monique R M
MR
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Bax
Jeroen J
JJ
Lamb
Hildo J
HJ
Dirksen
Martijn S
MS
Zeppenfeld
K
K
van der Wall
Ernst E
EE
de Roos
Albert
A
Schalij
Martin J
MJ
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery; D017115:Catheter Ablation; D004452:Echocardiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional