title: 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.
abstract: 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.
authors.affiliation: Medizinische Klinik, Klinikum Coburg, Coburg, Germany. georgnoelker@yahoo.com
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
authors.forename: Klaus Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Harald
authors.initials: H
authors.lastname: Marschang
authors.forename: Guido
authors.initials: G
authors.lastname: Ritscher
authors.forename: Stefan
authors.initials: S
authors.lastname: Asbach
authors.forename: Nassir
authors.initials: N
authors.lastname: Marrouche
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Anil Martin
authors.initials: AM
authors.lastname: Sinha
mesh_terms: 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*