Left atrium and pulmonary vein imaging using sub-millisiviert cardiac computed tomography: Impact on radiofrequency catheter ablation cumulative radiation exposure and outcome in atrial fibrillation patients

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• 作者：Gianluca Pontone^a ; ^{gianluca.pontone@ccfm.it} ; Daniele Andreini^a ; ^b ; Maria Petulla^a ; Andrea Annoni^a ; Andrea I. Guaricci^c ; Ester Innocenti^a ; Eleonora Russo^a ; Marco Guglielmo^a ; Saima Mushtaq^a ; Andrea Baggiano^a ; Virginia Beltrama^a ; Laura Fusini^a ; Chiara Segurini^a ; Edoardo Conte^a ; Alberto Formenti^a ; Gaetano Fassini^a ; Stefania Riva^a ; Claudio Tondo^a ; Piergiuseppe Agostoni^a ; ^b ; Antonio L. Bartorelli^a ; ^d ; Mauro Pepi^a
• 关键词：Atrial fibrillation ; Ablation ; Radiation exposure ; Iterative reconstruction algorithm ; Outcome
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：805-811
• 全文大小：607 K
• 卷排序：228

文摘

The outcome of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has improved thanks to left atrium (LA) anatomy reconstruction by cardiac computed tomography (CCT). A new model-based iterative reconstruction algorithm (MBIR) provides image noise reduction achieving effective radiation dose (ED) close to chest X-ray exposure. Aim of this study was comparing RFCA procedural characteristics, AF recurrence and radiation exposure between patients in whom RFCA was guided by CCT image integration with MBIR versus a CCT standard protocol.MethodsThree-hundred consecutive patients with drug-refractory AF were studied with CCT using MBIR (Group 1; N:150) or CCT with standard protocol (Group 2; N:150) for LA evaluation and treated by image integration-supported RFCA. Image noise, signal to noise ratio (SNR), contrast to noise ratio (CNR), RFCA procedural characteristics, rate of AF recurrence and radiation exposure were compared.ResultsGroup 1 showed higher SNR (25.9 ± 7.1 vs. 16.2 ± 4.8, p < 0.001) and CNR (23.3 ± 7.1 vs. 12.2 ± 4.2, p < 0.001) and lower image noise (22.3 ± 5.2 vs. 32.6 ± 8.1 HU, p < 0.001), fluoroscopy time (21 ± 12 vs. 29 ± 15 min, p < 0.01) and procedural duration (135 ± 89 vs. 172 ± 55, p < 0.001). Group 1 showed a 94% reduction of ED as compared to Group 2 (CCT-ED related: 0.41 ± 0.04 vs. 6.17 ± 4.11 mSv, p < 0.001; cumulative CCT + RFCA-ED related: 21.9 ± 17.9 vs. 36.0 ± 24.1 mSv, p < 0.001) with similar rate of AF recurrence (25% vs. 29%, p = 0.437).ConclusionsCCT with MBIR allows accurate reconstruction of LA anatomy in AF patients undergoing RFCA with a sub-millisievert ED and comparable success rate of RFCA as compared to a standard CCT scan protocol.