title: Incidental extracardiac findings in cardiac computed tomography performed before radiofrequency ablation of atrial fibrillation.
abstract: BACKGROUND
  Radiofrequency ablation has became a validated therapeutic technique for symptomatic drug refractory atrial fibrillation (AF). Cardiac computed tomography (CT) is used to evaluate left atrial (LA) anatomy in order to improve AF ablation. The analysis of noncardiac structures during cardiac CT may identify clinically significant incidental findings (IFs). The objective of this study was to determine the prevalence of IF in patients undergoing AF catheter ablation.
  
  
  METHODS
  Between February 2008 and March 2010, all patients planned for a first procedure of AF or LA tachycardia (LAT) ablation underwent a cardiac CT scan and were retrospectively included in this study. Extracardiac IFs were considered to be present if an abnormality was identified without previous clinical suspicion or known disease.
  
  
  RESULTS
  Two hundred and fifty patients (55.2 ± 9.6 years of age, 82.4% men) were enrolled (133 paroxysmal, 43 persistent, 58 permanent AF, and 16 LAT). Fifty-eight patients (23.2%) had a total of 76 IFs. Patients with IF were significantly older (59.5 ± 8.2 vs 53.8 ± 9.7 years old, P < 0.001). No relationship existed between the type of arrhythmia and IF existence. The majority of IFs were pulmonary (50%), with 15.8% of pulmonary emphysema. Two cases of lung cancer and of pulmonary fibrosis, 15 mediastinal adenopathies, and three congenital coronary arteries anomalies were found.
  
  
  CONCLUSIONS
  Cardiac CT scan is a useful tool to evaluate LA morphology before AF ablation. However, as a considerable prevalence of IF was found in our study, extracardiac structures should be routinely analyzed to detect unknown conditions, which could require specific management.
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France. raphael.pmartins@gmail.com
authors.forename: Raphaël Pedro
authors.initials: RP
authors.lastname: Martins
authors.forename: Lucian
authors.initials: L
authors.lastname: Muresan
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sellal
authors.forename: Damien
authors.initials: D
authors.lastname: Mandry
authors.forename: Denis
authors.initials: D
authors.lastname: Régent
authors.forename: Soumaya
authors.initials: S
authors.lastname: Jarmouni
authors.forename: Laurent
authors.initials: L
authors.lastname: Groben
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Zinzius
authors.forename: Jérôme
authors.initials: J
authors.lastname: Schwartz
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Magnin-Poul
authors.forename: Marius
authors.initials: M
authors.lastname: Andronache
authors.forename: Etienne
authors.initials: E
authors.lastname: Aliot
authors.forename: Christian
authors.initials: C
authors.lastname: De Chillou
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*