title: Accuracy of 64-multidetector computed tomography coronary angiography in patients with symptomatic atrial fibrillation prior to pulmonary vein isolation.
abstract: OBJECTIVE
  Aim of our study was to investigate the value of multidetector computed tomography (MDCT) for detecting significant stenoses of coronary arteries in patients with symptomatic atrial fibrillation (AF) prior to pulmonary vein (PV) ablation (PVA).
  
  
  BACKGROUND
  Many patients undergoing PVA for AF receive three-dimensional computed tomography or magnetic resonance tomography imaging for improving anatomical orientation.
  
  
  METHODS
  One-hundred and eighty-one patients with AF refractory to antiarrhythmic treatment underwent ECG-gated 64-MDCT for identification of PV anatomy and simultaneous assessment of coronary vessels before PVA. No additional radiation was incurred for MDCT coronary angiography during MDCT scan. Pretest probability for obstructive coronary artery disease (CAD) was estimated. Invasive coronary angiography (ICA) was performed in all patients with at least intermediate risk of CAD.
  
  
  RESULTS
  Eighty-six out of 181 patients (48%) had ICA and MDCT, 95 patients (52%) underwent MDCT alone. ICA revealed significant stenoses in 9% of the catheterized patients (8/86). MDCT investigation lead to a sensitivity of 90% (9/10), specificity of 98% (829/844 lesions), positive predictive value (PPV) of 39% (9/24), and negative predictive value (NPV) of 100% (829/830 lesions) for the detection of >50% stenoses seen on ICA. All patients with a significant stenosis were classified as patients with CAD. Overall prevalence of significant CAD detected by MDCT was found to be low with 10% of patients and 2% of all segments.
  
  
  CONCLUSIONS
  MDCT coronary angiography is sensitive and highly specific in patients presenting for PVA. In this group a negative scan reliably excludes significant CAD. These data suggest that MDCT coronary angiography can replace ICA prior to PVA.
authors.affiliation: Department of Cardiology and Pneumology, Heart Center, Georg August University, Robert-Koch-Strasse 40, Göttingen, Germany. csohns@med.uni-goettingen.de
authors.forename: Christian
authors.initials: C
authors.lastname: Sohns
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kruse
authors.forename: Dirk
authors.initials: D
authors.lastname: Vollmann
authors.forename: Lars
authors.initials: L
authors.lastname: Lüthje
authors.forename: Marc
authors.initials: M
authors.lastname: Dorenkamp
authors.forename: Joachim
authors.initials: J
authors.lastname: Seegers
authors.forename: Claudius
authors.initials: C
authors.lastname: Jacobshagen
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Silvia
authors.initials: S
authors.lastname: Obenauer
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuss
authors.forename: Markus
authors.initials: M
authors.lastname: Zabel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011300:Preoperative Care; D011667:Pulmonary Veins / Q000601:surgery; D055815:Young Adult