Noninvasive cardiology
Abstract
Multislice Computed Tomography Versus Intracardiac Echocardiography to Evaluate the Pulmonary Veins Before Radiofrequency Catheter Ablation of Atrial Fibrillation

https://doi.org/10.1016/j.accreview.2005.04.062Get rights and content

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Study Question

The study compared the ability of multislice computed tomography (MSCT) and intracardiac echocardiography (ICE) to evaluate pulmonary vein (PV) anatomy in patients presenting for radiofrequency catheter ablation (RFCA) of atrial fibrillation.

Methods

Both MSCT and ICE were performed in 42 patients presenting for RFCA of atrial fibrillation; MSCT was performed before the electrophysiologic procedure and ICE at the time of RFCA. The MSCT was considered the anatomic standard to which ICE was compared.

Results

A total of 181 PVs were found with MSCT, 175 of which were identified by ICE. The MSCT identified 13 patients as having an additional PV compared to only 7 by ICE. The MSCT identified a common ostium of the right PV in 13 and of the left PV in 33 compared to 16 and 31 by ICE. The ICE procedure tended to underestimate the superior inferior diameter of PVs compared to MSCT.

Conclusions

The PV anatomy is highly variable in patients presenting for RFCA of atrial fibrillation, and MSCT identifies more “anomalies” of PV anatomy than does ICE.

Perspective

Results of this study are not surprising, in that MSCT can be configured to provide high-resolution three-dimensional (3D) imaging of atrial anatomy including PVs, whereas ICE provides only a two-dimensional single tomographic view of this anatomy. The degree to which the underestimation of dimension by ICE is of clinical relevance is uncertain; however, the added anatomic information regarding additional PVs or common ostia has potential implications with respect to therapy. Both MSCT and ICE

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