Adenosine-induced ventricular asystole or rapid ventricular pacing to enhance three-dimensional rotational imaging during cardiac ablation procedures.
OBJECTIVE
Rotational angiography with digital three-dimensional reconstruction (3DRA) allows per-procedural 3D imaging to facilitate cardiac ablation procedures. We developed a new approach that allows per-procedural 3D imaging of the atria and ventricles with a single C-arm rotation, combining higher 3D image quality with a lower contrast and radiation dose.


RESULTS
Forty patients underwent 3DRA of the left atrium (LA, n = 26), right atrium (RA, n = 11), left ventricle (LV, n = 2), or right ventricle (RV, n = 1) during ablation procedures performed under general anaesthesia. Contrast agent (60 +/- 12 mL) was diluted and injected directly in the chamber of interest, during adenosine-induced ventricular asystole (n = 31) or rapid RV pacing (n = 9, atrial imaging only) to reduce cardiac motion artefacts and enhance contrast opacification during rotational imaging. Reconstructed 3D data sets were graded according to predefined quality criteria (n = 40) and quantitatively compared with cardiac computed tomography (CT) (LA, n = 14). Adenosine-induced ventricular asystole and rapid pacing both allowed a sustained and homogeneous contrast opacification of target cardiac chambers, resulting in useful 3D data sets in 39 of 40 (98%) patients. Moreover, it was possible to achieve 'good' or 'optimal' 3D image quality in the majority of patients (adenosine: 61%, pacing 78%, P = 0.69). When compared with rapid pacing, the total elimination of cardiac motion artefacts with adenosine more frequently resulted in 'optimal' 3D image quality (42% vs. 11%, P = 0.01) and added the possibility for single-rotation 3D imaging of the ventricles. Quantitative analysis showed an excellent agreement between pulmonary vein diameters measured on cardiac CT and 3DRA images. Integration of 3DRA-based LA surfaces with real-time fluoroscopy was easy and highly accurate.


CONCLUSIONS
Adenosine-induced ventricular asystole or rapid ventricular pacing allow acquisition of 3DRA with an excellent direct contrast opacification of any cardiac chamber and a reduction of cardiac motion artefacts, resulting in high-quality per-procedural 3D imaging with a single C-arm rotation.
Ector
Joris
J
Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Gasthuisberg Herestraat 49, B-3000 Leuven, Belgium. joris.ector@uz.kuleuven.ac.be
De Buck
Stijn
S
Nuyens
Dieter
D
Rossenbacker
Tom
T
Huybrechts
Wim
W
Gopal
Razeen
R
Maes
Frederik
F
Heidbüchel
Hein
H
D000241:Adenosine; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*; D018511:Systems Integration; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*
D000241:Adenosine