title: Intraprocedural imaging of left atrium and pulmonary veins: a comparison study between rotational angiography and cardiac computed tomography.
abstract: BACKGROUND
  Atrial fibrillation (AF) ablation is facilitated by anatomical visualization of the left atrium (LA) and the pulmonary veins (PVs). The purpose of this study was to compare accuracy, radiation exposure, and costs between three-dimensional atriography (3D-ATG) and cardiac computed tomography (CCT).
  
  
  METHODS
  Seventy patients with an indication for AF ablation were included. Contrast-enhanced CCT was performed preoperatively for all patients. In addition, intraoperative 3D-ATG was performed with contrast medium injection either indirectly into the pulmonary arteries during a breath-hold (Ind.-RTA, n = 25) or directly into the LA, during adenosine-induced asystole (Ad.-RTA, n = 23), or rapid ventricular pacing (VP-RTA, n = 22). We evaluated vertical ostial PV diameters and LA volume, time needed to perform, radiation exposure, and procedural cost for each imaging method.
  
  
  RESULTS
  The correlation coefficient between 3D-ATG and CCT for the ostial PV diameters was r = 0.83 for Ind.-RTA, 0.91 for Ad.-RTA, and 0.88 for the VP-RTA method (P > 0.05). The volume correlations were r = 0.87 for Ind.-RTA, 0.82 for Ad.-RTA, and 0.8 for VP-RTA (P > 0.05). Time to perform was 13 ± 5 minutes for ATG and 46 ± 9 minutes for CCT (P < 0.05). Effective radiation dose was 2.2 ± 0.2 mSv for ATG and 20.4 ± 7.4 mSv for CCT (P < 0.05). The procedural cost was estimated at 91-95 € for ATG and at 126-151 € for CCT.
  
  
  CONCLUSIONS
  3D-ATG is an intraprocedural imaging modality that provides anatomical accuracy comparable to that of CCT with significantly lower radiation dose, in less time and at less financial expense (PACE 2011; 34:315-322).
authors.affiliation: Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. kriatselis@dhzb.de
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kriatselis
authors.forename: Sotirios
authors.initials: S
authors.lastname: Nedios
authors.forename: Spyridon
authors.initials: S
authors.lastname: Akrivakis
authors.forename: Min
authors.initials: M
authors.lastname: Tang
authors.forename: Mattias
authors.initials: M
authors.lastname: Roser
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Gerds-Li
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Michael
authors.initials: M
authors.lastname: Orlov
mesh_terms: D000792:Angiography / Q000379:methods*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D015203:Reproducibility of Results; D012399:Rotation; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome