A new approach for contrast-enhanced X-ray imaging of the left atrium and pulmonary veins for atrial fibrillation ablation: rotational angiography during adenosine-induced asystole.
OBJECTIVE
Atrial fibrillation ablation is a complex procedure that requires detailed anatomic information about left atrium (LA) and pulmonary veins (PVs). The goal of this study was to test rotational angiography of the LA during adenosine-induced asystole as an imaging tool in patients undergoing atrial fibrillation ablation.


RESULTS
Seventy patients with paroxysmal or persistent atrial fibrillation undergoing PV isolation were included. After transseptal puncture, adenosine (30 mg) was given intravenously, and during atrioventricular block, contrast medium was directly injected in the LA; a rotational angiography was performed (right anterior oblique 55 degrees to left anterior oblique 55 degrees). Rotational angiography images were assessed qualitatively in all patients and quantitatively in 45 patients in comparison with computed tomography (CT) images. The majority of rotational angiography imaging data (94%) were deemed at least 'useful' in delineating the LA-PV anatomy. The so-called 'ridge' between left superior PV and left atrial appendage was delineated in 90% of the patients. All accessory PVs were independently identified by rotational angiography and CT. A blinded quantitative comparison of PV ostial diameters showed an excellent correlation between rotational angiography and CT measurements (r > 0.90 for all PVs). No serious adverse effects occurred in association with adenosine.


CONCLUSIONS
Intra-procedural contrast-enhanced rotational angiography of the LA-PV during adenosine-induced asystole is feasible and provides anatomical information of high diagnostic value for atrial fibrillation ablation.
Kriatselis
Charalampos
C
Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. kriatselis@dhzb.de
Tang
Min
M
Roser
Mattias
M
Fleck
Eckart
E
Gerds-Li
Hong
H
D000241:Adenosine; D000792:Angiography / Q000379:methods*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D003287:Contrast Media; D006323:Heart Arrest / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000601:surgery*; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D015641:Radiography, Interventional / Q000379:methods; D012399:Rotation; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014665:Vasodilator Agents
D003287:Contrast Media; D014665:Vasodilator Agents; C057937:iomeprol; D007479:Iopamidol; D000241:Adenosine