Visualization of pulmonary vein stenosis after radio frequency ablation using multi-slice computed tomography: initial clinical experience in 33 patients.
OBJECTIVE
Radio frequency ablation (RFA) of the pulmonary veins (PV) is an established technique for treatment of atrial fibrillation (AF). However, stenoses within the treated areas are well known complications. Thus, a reliable non-invasive diagnosis of PV stenosis would be an important step forward in the care of these patients (pts). Aim of the present study was the diagnostic accuracy of new multi-slice detected computed tomography (MSCT) in visualization of PV and in detecting PV stenosis.


METHODS
A total of 33 pts (17 male, 16 female, mean age 57+/-10.2 years [40-71]) were included. Retrospectively ECG-gated CT angiography (CTA) was performed within 1 day to a maximum of 380 days after RFA with a MSCT scanner. Interpretation of the scan was performed on conventional contrast enhanced axial slices and on 3D volume rendering images (maximum intensity projection: MIP, multi-planar reconstruction: MPR). Lesion severity was determined on a semi-quantitative scale (mild: <20%, intermediate: 20-50%, severe >50%) and compared to conventional angiography which had been performed at the beginning and at the end of RFA.


RESULTS
MSCTA was applied without any complications, and all treated pulmonary veins (n=73) could be visualized. Diagnostic image quality was obtained in all examinations. A significant stenosis was detected by conventional angiography in 26/73 (36%) PV (2/73 (3%) severe, 14/73 (19%) intermediate, 10/73 (14%) mild). Using MSCTA, only 13 stenosis in 73 treated PV could be visualized (1/73 (1%) severe, 6/73 (8%) intermediate, 6/73 (8%) mild).


CONCLUSIONS
Multi-slice-detector CT is able to visualize PV and to detect PV stenoses. However, stenosis severity seems to be underestimated and not all lesions could be accurately detected. Larger studies have to be performed to further assess the diagnostic accuracy and clinical reliability of this new non-invasive method and to focus on the incidence of PV stenosis following RFA especially in long-time follow up.
Department of Internal Medicine, Division of Cardiology, Eberhard-Karls-University Tuebingen, Otfried-Mueller-Str. 10, 72076 Tuebingen, Germany.
Christof
C
Burgstahler
Tobias
T
Trabold
Axel
A
Kuettner
Andreas F
AF
Kopp
Christian
C
Mewis
Volker
V
Kuehlkamp
Claus D
CD
Claussen
Stephen
S
Schroeder
D000328:Adult; D000368:Aged; D000792:Angiography; D001281:Atrial Fibrillation / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000601:surgery; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*