Low-Dose Electrocardiography Synchronized Nonenhanced Computed Tomography for Assessing Left Atrium and Pulmonary Veins Before Radiofrequency Catheter Ablation for Atrial Fibrillation

      Recently contrast-enhanced cardiac computed tomography (CT) was found to be useful for imaging the left atrium and pulmonary veins (PVs) before radiofrequency catheter ablation in patients with atrial fibrillation. However, the risks of contrast agent in patients with impaired renal function must be considered. We investigated the accuracy of low-dose electrocardiographically synchronized nonenhanced cardiac CT (NECT) for identifying PV anatomy. One hundred eight consecutive patients who underwent cardiac CT before radiofrequency catheter ablation of atrial fibrillation were included. Nonenhanced cardiac computed tomogram was retrospectively evaluated for each patient by 2 radiologists for the following PV anatomy: conventional pattern, conjoined ostium, and accessory PVs with number and location. Sensitivity and specificity for variations in PVs were calculated using contrast-enhanced cardiac computed tomogram as the reference standard. Detection rates for each variation were also calculated. Twenty-one right PV (RPV) variations and 11 left PV (LPV) variations were observed. NECT showed a high diagnostic performance in detecting variations in PVs for the 2 observers. For RPV variations overall sensitivity was 97.6% and specificity was 96.6%. For LPV variations overall sensitivity was 90.9% and specificity was 97.9%. Overall detection rates for variation between the 2 observers were 97.1% for accessory RPV from the right middle lobe, 100% for 4 ostia with accessory RPV from the right middle lobe and accessory RPV from the superior segment of the right lower lobe, 100% for accessory RPV from the superior segment of the right lower lobe, 88.9% for conjoined ostium of the LPV, and 100% for accessory LPV from the left lingular segment. In conclusion, variations in PV anatomy were detected with great accuracy by NECT.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pappone C.
        • Rosanio S.
        • Oreto G.
        • Tocchi M.
        • Gugliotta F.
        • Vicedomini G.
        • Salvati A.
        • Dicandia C.
        • Mazzone P.
        • Santinelli V.
        • Gulletta S.
        • Chierchia S.
        Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation.
        Circulation. 2000; 102: 2619-2628
        • Shah D.C.
        • Haïssaguerre M.
        • Jaïs P.
        • Hocini M.
        • Yamane T.
        • Deisenhofer I.
        • Garrigue S.
        • Clémenty J.
        Electrophysiologically guided ablation of the pulmonary veins for the curative treatment of atrial fibrillation.
        Ann Med. 2000; 32: 408-416
        • Oral H.
        • Knight B.P.
        • Tada H.
        • Ozaydin M.
        • Chugh A.
        • Hassan S.
        • Scharf C.
        • Lai S.W.
        • Greenstein R.
        • Pelosi Jr, F.
        • Strickberger S.A.
        • Morady F.
        Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation.
        Circulation. 2002; 105: 1077-1081
        • Lacomis J.M.
        • Wigginton W.
        • Fuhrman C.
        • Schwartzman D.
        • Armfield D.R.
        • Pealer K.M.
        Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation.
        Radiographics. 2003; 23: S35-S50
        • Cohen M.C.
        • Hartnell G.G.
        • Finn J.P.
        Magnetic resonance angiography of congenital pulmonary vein anomalies.
        Am Heart J. 1994; 127: 954-955
        • Lin W.S.
        • Prakash V.S.
        • Tai C.T.
        • Hsieh M.H.
        • Tsai C.F.
        • Yu W.C.
        • Lin Y.K.
        • Ding Y.A.
        • Chang M.S.
        • Chen S.A.
        Pulmonary vein morphology in patients with paroxysmal atrial fibrillation initiated by ectopic beats originating from the pulmonary veins: implications for catheter ablation.
        Circulation. 2000; 101: 1274-1281
        • Pilleul F.
        • Merchant N.
        MRI of the pulmonary veins: comparison between 3D MR angiography and T1-weighted spin echo.
        J Comput Assist Tomogr. 2000; 24: 683-687
        • Tsao H.M.
        • Yu W.C.
        • Cheng H.C.
        • Wu M.H.
        • Tai C.T.
        • Lin W.S.
        • Ding Y.A.
        • Chang M.S.
        • Chen S.A.
        Pulmonary vein dilation in patients with atrial fibrillation: detection by magnetic resonance imaging.
        J Cardiovasc Electrophysiol. 2001; 12: 809-813
        • Schwartzman D.
        • Lacomis J.
        • Wigginton W.G.
        Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomography.
        J Am Coll Cardiol. 2003; 41: 1349-1357
        • Bettmann M.A.
        The evaluation of contrast-related renal failure.
        AJR Am J Roentgenol. 1991; 157: 66-68
        • Broome D.R.
        • Girguis M.S.
        • Baron P.W.
        • Cottrell A.C.
        • Kjellin I.
        • Kirk G.A.
        Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned.
        AJR Am J Roentgenol. 2007; 188: 586-592
        • Cronin P.
        • Sneider M.B.
        • Kazerooni E.A.
        • Kelly A.M.
        • Scharf C.
        • Oral H.
        • Morady F.
        MDCT of the left atrium and pulmonary veins in planning radiofrequency ablation for atrial fibrillation: a how-to guide.
        AJR Am J Roentgenol. 2004; 183: 767-778