Intraprocedural volume imaging of the left atrium and pulmonary veins with rotational X-ray angiography: implications for catheter ablation of atrial fibrillation.
BACKGROUND
The use of preprocedural CT or MR imaging to generate patient-specific cardiac anatomy greatly facilitates catheter ablation of the left atrium and pulmonary veins (LA-PVs) to treat atrial fibrillation (AF). This report details the accuracy and utility of an intraprocedural means to generate 3-D volumetric renderings of the LA-PV anatomy: contrast-enhanced rotational X-ray angiography (3DRA).


RESULTS
Preprocedural CT or MR imaging and intraprocedural rotational angiography was performed in 42 patients undergoing AF ablation procedures. Initially, pulmonary artery (PA) bolus-chase contrast injections were performed (20 mL, 20 mL/s) to establish pulmonary transit time and cardiac isocentering. Depending on cardiac size, either a single PA injection (80-100 mL, 20 mL/s) or two separate dedicated left/right PA branch injections were performed (60 mL each, 20 mL/s). For the latter, the two volumes of the left/right portions of the LA-PVs were registered and fused. LA-PV 3DRA images were assessed qualitatively and quantitatively in comparison with CT/MR images. The majority of the 3DRA acquisitions (71%) were deemed at least "useful" in delineating the LA-PV anatomy. The LA appendage was delineated in 57% of the cases. A blinded quantitative comparison of PV ostial diameters resulted in an absolute difference of only 2.7 +/- 2.3 mm, 2.2 +/- 1.8 mm, 2.4 +/- 2.2 mm, and 2.2 +/- 2.3 mm for the left-superior, left-inferior, right-superior, and right-inferior PVs, respectively. The feasibility for registering the 3DRA image with real-time electroanatomical mapping was also demonstrated.


CONCLUSIONS
Intraprocedural contrast-enhanced rotational angiography provides volumetric 3-D images of the LA-PVs of comparable diagnostic value to dedicated preprocedural CT/MR imaging.
Thiagalingam
Aravinda
A
Cardiac Electrophysiology Department, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Manzke
Robert
R
D'Avila
Andre
A
Ho
Ivan
I
Locke
Andrew H
AH
Ruskin
Jeremy N
JN
Chan
Raymond C
RC
Reddy
Vivek Y
VY
D000792:Angiography / Q000379:methods*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000601:surgery; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D015641:Radiography, Interventional / Q000379:methods; D012399:Rotation; D016037:Single-Blind Method; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome