title: Impact of cardiac computed tomography of the interatrial septum before pulmonary vein isolation.
abstract: BACKGROUND
  Multidetector computed tomography (MDCT) may be useful to identify patients with patent foramen ovale (PFO). The aim of this study was to analyze whether a MDCT performed before pulmonary vein isolation reliably detects a PFO that may be used for access to the left atrium.
  
  
  RESULTS
  In 79 consecutive patients, who were referred for catheter ablation of symptomatic paroxysmal or persistent atrial fibrillation (AF), the presence of a PFO was explored by MDCT and transesophageal echocardiography (TEE). TEE was considered as the gold standard, and quality of TEE was good in all patients. In 16 patients (20.3%), MDCT could not be used for analysis because of artifacts, mainly because of AF. On TEE, a PFO was found in 15 (23.8%) of the 63 patients with usable MDCT. MDCT detected six PFO of which four were present on TEE. This corresponded to a sensitivity of 26.7%, a specificity of 95.8%, a negative predictive value of 80.7%, and a positive predictive value of 66.7%. The receiver operating characteristics curve of MDCT for the detection of PFO was 0.613 (95% confidence interval 0.493-0.732).
  
  
  CONCLUSIONS
  MDCT may detect a PFO before pulmonary isolation. However, presence of AF may lead to artifacts on MDCT impeding a meaningful analysis. Furthermore, in this study sensitivity and positive predictive value of MDCT were low and therefore MDCT was not a reliable screening tool for detection of PFO.
authors.affiliation: Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland.
authors.forename: Richard
authors.initials: R
authors.lastname: Kobza
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Schoenenberger
authors.forename: Florim
authors.initials: F
authors.lastname: Cuculi
authors.forename: Michel
authors.initials: M
authors.lastname: Zuber
authors.forename: Christoph
authors.initials: C
authors.lastname: Auf Der Maur
authors.forename: Ralf
authors.initials: R
authors.lastname: Buhmann
authors.forename: Therese J
authors.initials: TJ
authors.lastname: Resink
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D054087:Atrial Septum / Q000000981:diagnostic imaging*; D015897:Comorbidity; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000706:statistics & numerical data*; D011300:Preoperative Care; D015995:Prevalence; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
keywords: atrial fibrillation; patent foramen ovale; pulmonary vein isolation