Three-dimensional left atrial and esophagus reconstruction using cardiac C-arm computed tomography with image integration into fluoroscopic views for ablation of atrial fibrillation: accuracy of a novel modality in comparison with multislice computed tomography.
BACKGROUND
Visualization of the left atrium (LA) and pulmonary veins (PVs) is crucial in PV isolation (PVI). Additional delineation of the esophagus might avoid severe side effects. Cardiac C-arm computed tomography (DynaCT Cardiac, Siemens AG, Forchheim, Germany) has been introduced as a novel intraprocedural imaging modality based on a rotational angiography.


OBJECTIVE
The purpose of this study was to prove the quantitative accuracy of DynaCT Cardiac as compared with multislice CT (MSCT) in imaging of the LA and PV in patients undergoing PVI.


METHODS
Thirty-four consecutive patients (22 male, age 64 +/- 12 years) with symptomatic atrial fibrillation (AF) and indication for PVI were studied. Diameters of the PV, the LA appendage (LAA), and the descending aorta were measured, and the position of the esophagus was defined using preprocedural MSCT and intraprocedural DynaCT Cardiac.


RESULTS
There was a significant correlation between both measurements for diameters of the LAA (r = 0.86, P <.05), PV (r = 0.98, P <.05), and the descending aorta (r = 0.98, P <.05). The overall correlation of vessel diameters was r = 0.99. The LA volumes correlation was r = 0.86 and P <.05. A significant difference of the esophageal position was found between preprocedural MSCT and intraprocedural DynaCT Cardiac (r = 0.53, P <.05).


CONCLUSIONS
DynaCT Cardiac is a novel intraprocedural rotational angiographic technique. It is highly accurate in displaying crucial structures for PVI in comparison with the results of MSCT. Therefore, DynaCT Cardiac can be used as an alternative imaging technique to improve PVI accuracy.
Nölker
Georg
G
Medizinische Klinik, Klinikum Coburg, Coburg, Germany. georgnoelker@yahoo.com
Gutleben
Klaus Jürgen
KJ
Marschang
Harald
H
Ritscher
Guido
G
Asbach
Stefan
S
Marrouche
Nassir
N
Brachmann
Johannes
J
Sinha
Anil Martin
AM
D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery; D017115:Catheter Ablation; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*