Integration of cardiac computed tomography into pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Detailed anatomic information of the left atrium is necessary for securely performing radiofrequency ablation of atrial fibrillation-triggering ectopies in the pulmonary vein ostia. In this study the impact of a preinterventionally acquired cardiac computed tomography (CT) on pulmonary vein isolation (PVI) was assessed. Examinations of 54 patients with paroxysmal atrial fibrillation undergoing PVI were analyzed. In 27 patients a supplementary cardiac CT was obtained prior to PVI (CT group, 12 women, 15 men, 59.7+/-9.9 years of age): 16 x 1.5 mm collimation, 0.2 pitch, 120 kV tube voltage, 400 effective mAs. The fluoroscopy time, effective dose and quantity of radiofrequency (RF) pulses of the following catheter ablation were compared to 27 patients undergoing stand-alone PVI (11 women, 16 men, 62.0+/-9.9 years of age). Mann-Whitney tests served for statistical comparison. CT datasets were successfully integrated into the ablation procedure of each patient in the CT group. The mean quantity of RF pulses was significantly lower in the CT group (22.1+/-8.0 vs. 29.1+/-11.9, p=0.030), and a significant reduction of fluoroscopy time was found (41.8+/-12.0 min vs. 51.2+/-16.0 min, p=0.005). Effective doses of the catheter ablation differed in an equivalent dimension but altogether not significantly (14.9+/-10.0 mSv vs. 20.0+/-16.0 mSv, p=0.203). The mean additive effective dose of the cardiac CT was 8.5+/-0.3 mSv. CT-guided ablation of atrial fibrillation requires less fluoroscopy time than stand-alone PVI. Due to the multi-faceted dependency of individual fluoroscopy doses, a consistent reduction of the effective dose was not observed. Since supplementary CT constitutes an additive dose, optimized CT atriography needs to be designed in order to provide sufficient image quality while reducing X-ray exposure. The reduction in RF pulses implies an increase in the effectiveness and safety of catheter ablation.