title: Intraprocedural volume imaging of the left atrium and pulmonary veins with rotational X-ray angiography: implications for catheter ablation of atrial fibrillation.
abstract: 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.
authors.affiliation: Cardiac Electrophysiology Department, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Thiagalingam
authors.forename: Robert
authors.initials: R
authors.lastname: Manzke
authors.forename: Andre
authors.initials: A
authors.lastname: D'Avila
authors.forename: Ivan
authors.initials: I
authors.lastname: Ho
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Locke
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Chan
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
mesh_terms: 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