open access

Vol 70, No 9 (2012)
Original articles - new methods
Published online: 2012-09-20
Submitted: 2012-12-28
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Value of rotational angiography (3D−ATG) with contrast agent administration into the right atrium during atrial fibrillation ablation procedures: a preliminary report

Artur Baszko, Magdalena Łanocha, Piotr Kałmucki, Marek Michalski, Olga Jerzykowska, Waldemar Elikowski, Anna Kociemba, Małgorzata Pyda, Tomasz Siminiak, Andrzej Szyszka
Kardiol Pol 2012;70(9):924-930.

open access

Vol 70, No 9 (2012)
Original articles - new methods
Published online: 2012-09-20
Submitted: 2012-12-28

Abstract

Background: Efficacy and safety of radiofrequency (RF) ablation in patients with atrial fibrillation (AF) strongly depend on the possibility of three-dimensional (3D) visualisation of atria as well as the ostia of pulmonary veins. Current angiographic systems allow 3D visualisation of anatomical heart structures using rotational angiography.
Aim:
To evaluate clinical usefulness of rotational angiography (3D-ATG) after contrast agent administration into the right atrium for the purpose of evaluating left atrial anatomy in patients undergoing RF ablation of AF.
Methods: We also compared images obtained using 3D-ATG with magnetic resonance imaging (MRI). In 18 consecutive patients undergoing RF ablation of AF or left-atrial tachycardia, 3D-ATG was performed uneventfully, followed by 3D reconstruction of the left atrium and the aorta. Ablation using the CARTO 3 system was successful in 17 patients. Total ablation time was 127 ± 28 min, fluoroscopy time 31 ± 8 min, and radiation dose was 413 ± 170 mGy. Mean fluoroscopy time for 3D-ATG was 1.75 ± 0.4 min and the mean radiation dose was 159 ± 57 mGy. Appropriate 3D visualisation of the left atrium was possible in 17 patients, including 16 patients in whom all 4 pulmonary venous ostia were imaged. In 1 patient, all right-sided pulmonary veins were located outside the scan area. In 1 case, 3D-ATG did not allow visualisation of the right inferior pulmonary vein, and in another case the left-sided veins had a common ostium as shown in MRI but not visualised in 3D-ATG.
Results: Pulmonary vein diameter assessed by 3D-ATG was slightly higher than by MRI (16.6 ± 3.2 vs. 15.2 ± 3.6 mm, p = 0.28), although this was mainly related to a single nonvisualised right inferior pulmonary vein. Good agreement (< 2 mm) between the two methods for the assessment of pulmonary venous ostia was higher for the right-sided than the left-sided veins (62.5% vs. 44%, p = 0.03).
Conclusions: We conclude that 3D-ATG after contrast agent administration into the right atrium seems to be a safe and effective method to visualise pulmonary venous ostia and left atrial anatomy. It remains to be established whether it enables evaluation of anatomical anomalies.

Abstract

Background: Efficacy and safety of radiofrequency (RF) ablation in patients with atrial fibrillation (AF) strongly depend on the possibility of three-dimensional (3D) visualisation of atria as well as the ostia of pulmonary veins. Current angiographic systems allow 3D visualisation of anatomical heart structures using rotational angiography.
Aim:
To evaluate clinical usefulness of rotational angiography (3D-ATG) after contrast agent administration into the right atrium for the purpose of evaluating left atrial anatomy in patients undergoing RF ablation of AF.
Methods: We also compared images obtained using 3D-ATG with magnetic resonance imaging (MRI). In 18 consecutive patients undergoing RF ablation of AF or left-atrial tachycardia, 3D-ATG was performed uneventfully, followed by 3D reconstruction of the left atrium and the aorta. Ablation using the CARTO 3 system was successful in 17 patients. Total ablation time was 127 ± 28 min, fluoroscopy time 31 ± 8 min, and radiation dose was 413 ± 170 mGy. Mean fluoroscopy time for 3D-ATG was 1.75 ± 0.4 min and the mean radiation dose was 159 ± 57 mGy. Appropriate 3D visualisation of the left atrium was possible in 17 patients, including 16 patients in whom all 4 pulmonary venous ostia were imaged. In 1 patient, all right-sided pulmonary veins were located outside the scan area. In 1 case, 3D-ATG did not allow visualisation of the right inferior pulmonary vein, and in another case the left-sided veins had a common ostium as shown in MRI but not visualised in 3D-ATG.
Results: Pulmonary vein diameter assessed by 3D-ATG was slightly higher than by MRI (16.6 ± 3.2 vs. 15.2 ± 3.6 mm, p = 0.28), although this was mainly related to a single nonvisualised right inferior pulmonary vein. Good agreement (< 2 mm) between the two methods for the assessment of pulmonary venous ostia was higher for the right-sided than the left-sided veins (62.5% vs. 44%, p = 0.03).
Conclusions: We conclude that 3D-ATG after contrast agent administration into the right atrium seems to be a safe and effective method to visualise pulmonary venous ostia and left atrial anatomy. It remains to be established whether it enables evaluation of anatomical anomalies.
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Keywords

atrial fibrillation; rotational angiography; magnetic resonance imaging

About this article
Title

Value of rotational angiography (3D−ATG) with contrast agent administration into the right atrium during atrial fibrillation ablation procedures: a preliminary report

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 70, No 9 (2012)

Pages

924-930

Published online

2012-09-20

Bibliographic record

Kardiol Pol 2012;70(9):924-930.

Keywords

atrial fibrillation
rotational angiography
magnetic resonance imaging

Authors

Artur Baszko
Magdalena Łanocha
Piotr Kałmucki
Marek Michalski
Olga Jerzykowska
Waldemar Elikowski
Anna Kociemba
Małgorzata Pyda
Tomasz Siminiak
Andrzej Szyszka

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