Incidental Extracardiac Findings in Cardiac Computed Tomography Performed before Radiofrequency Ablation of Atrial Fibrillation

Martins, Raphaël P.; Mureşan, Lucian; Sellal, Jean‐Marc; Mandry, Damien; Régent, D; Jarmouni, Soumaya; Groben, Laurent; Zinzius, Pierre-Yves; Schwartz, Jérôme; Brembilla‐Perrot, Béatrice; Magnin-Poul, Isabelle; Andronache, Marius; Aliot, Étienne; Chillou, Christian de

doi:10.1111/j.1540-8159.2011.03194.x

Cited by 10 publications

(11 citation statements)

References 31 publications

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“…It is often discussed whether CMRIs should be checked for incidental findings at all and also whether extracardiac findings should be analyzed by follow‐up diagnostics or not . Further costs and stressful intensive diagnostics for each patient can be the result.…”

Section: Discussionmentioning

confidence: 99%

“…In a large cardiac CT study with a follow‐up period of 18.4 ± 7.6 months and age adjustment among 966 patients, 41.6% had extracardiac incidental findings. Costs for additional diagnostics in further imaging and procedures were 83,035 US dollars . There was no clear mortality benefit because extracardiac findings were not a distinct predictor for patient death, which may be due to the short follow‐up period.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and clinical relevance of extracardiac findings at cardiac MRI

Sohns¹,

Schwarz²,

Menke³

et al. 2013

Magnetic Resonance Imaging

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and clinical relevance of extracardiac findings at cardiac MRI

Sohns¹,

Schwarz²,

Menke³

et al. 2013

Magnetic Resonance Imaging

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“…There was also a high incidence of unclear benefit, limited follow-up period and different imaging methods applied [23]. [12,15,26]. These values are in the range of former CT studies for CAD detection as described before [10,11].…”

Section: Relevance Of the Study Findings With Comparison To The Litermentioning

confidence: 99%

“…Several cardiac and extra-cardiac findings were described after cardiac-specific CT examination studies and were subdivided into significant or non-significant [11,14,15]. In 179 of the 224 patients (80 %), one or more incidental extra-cardiac findings were noted per patient.…”

Section: Relevance Of the Study Findings With Comparison To The Litermentioning

confidence: 99%

Current Role of Cardiac and Extra-Cardiac Pathologies in Clinically Indicated Cardiac Computed Tomography with Emphasis on Status Before Pulmonary Vein Isolation

Sohns

Menke

Staab

et al. 2014

Fortschr Röntgenstr

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Purpose: The aim of this study was to assess the incidence of cardiac and significant extra-cardiac findings in clinical computed tomography of the heart in patients with atrial fibrillation before pulmonary vein isolation (PVI). Materials and Methods: 224 patients (64???10 years; male 63?%) with atrial fibrillation were examined by cardiac 64-slice multidetector CT before PVI. Extra-cardiac findings were classified as ?significant? if they were recommended to additional diagnostics or therapy, and otherwise as ?non-significant?. Additionally, cardiac findings were documented in detail. Results: A total of 724 cardiac findings were identified in 203 patients (91?% of patients). Additionally, a total of 619 extra-cardiac findings were?identified in 179 patients (80?% of patients). Among these extra-cardiac findings 196 (32?%) were ?significant?, and 423 (68?%) were ?non-significant?. In 2 patients (1?%) a previously unknown malignancy was detected (esophageal cancer and lung cancer, local stage, no metastasis). 203 additional imaging diagnostics followed to clarify the ?significant? findings (124 additional CT, costs 38?314.69 US dollars). Overall, there were 3.2 cardiac and 2.8 extra-cardiac findings per patient. Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p?<0.05). Conclusion: Cardiac CT scans before PVI should be screened for extracardiac incidental findings that could have important clinical implications for each patient. Key points: ??Cardiac and extra-cardiac findings are common in patients with an indication for pulmonary vein isolation on previous CT scans. ??Malignancies can be detected in 1?% of all patients. ??32?% of all extra-cardiac findings can be of significant relevance with consequences for patients. ??Altogether, there are 3.2 cardiac and 2.8 extra-cardiac findings in patients with indication for pulmonary vein isolation and CT. ??Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p?<0.05). Citation Format: ??Sohns JM, Menke J, Staab W et?al. Current Role of Cardiac and Extra-Cardiac Pathologies in Clinically Indicated Cardiac Computed Tomography with Emphasis on Status Before Pulmonary Vein Isolation. Fortschr R?ntgenstr 2014; 186: 860???867

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“…Incidental findings (IFs) are common on cardiac imaging prior to AFCA. However, there are only few studies that have mainly focused on radiological extracardiac IFs detected on preprocedural cardiac CT scan [3] , [4] , [5] , [6] . In contrast to CT imaging, CMR allows not only for radiation-free evaluation of the cardiac anatomy but also for detailed tissue characterization and functional assessment to detect underlying cardiac and adjacent extracardiac pathologies.…”

Section: Introductionmentioning

confidence: 99%

Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation

Ebert

Karrengarn

Jahnke

et al. 2022

IJC Heart & Vasculature

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Introduction Preprocedural cardiovascular magnetic resonance (CMR) or computed tomography (CT) imaging of the left atrium/pulmonary veins is usually employed to guide catheter ablation of atrial fibrillation (AFCA). Incidental findings (IFs) are common on cardiac imaging prior to AFCA. However, previous studies have mainly focused on extracardiac IFs detected on CT scan. We aimed to assess the prevalence of relevant cardiac and extracardiac IFs on routine preprocedural CMR in a large patient cohort scheduled for first-time AFCA and report its impact on clinical decision-making and management. Methods and results We included 2000 consecutive patients (62 ± 10 years; 59% male) who underwent CMR prior to first-time AFCA between April 2015 and March 2019. Among these patients 172 (8.6%) had a total of 184 major IFs. Detection of major IFs resulted in cancellation of the scheduled AFCA procedure in 88 patients (4.4%). Forty-two patients (2.1%) have never been ablated, 46 (2.3%) underwent postponed AFCA after a median time of 83 (32–213) days. The remaining 84 patients (4.2%) underwent an individualized approach to AFCA. The most common major IFs were accessory or anomalous PVs in 76 (3.8%), extracardiac abnormalities suspicious of malignancy in 29 (1.5%), and positive stress perfusion imaging in 19 (7.2% of 261 tested) patients. In 19 patients (1.0%) preprocedural CMR provided the diagnosis of a previously unknown structural cardiac disease. Conclusions Unexpected relevant findings on routine preprocedural CMR affected clinical decision-making and management in 8.6% of patients scheduled for first-time AFCA. However, whether preprocedural CMR imaging may improve overall clinical outcome needs to be addressed in future research.

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Incidental Extracardiac Findings in Cardiac Computed Tomography Performed before Radiofrequency Ablation of Atrial Fibrillation

Abstract: Cardiac CT scan is a useful tool to evaluate LA morphology before AF ablation. However, as a considerable prevalence of IF was found in our study, extracardiac structures should be routinely analyzed to detect unknown conditions, which could require specific management.

Cited by 10 publications

References 31 publications

Prevalence and clinical relevance of extracardiac findings at cardiac MRI

Prevalence and clinical relevance of extracardiac findings at cardiac MRI

Current Role of Cardiac and Extra-Cardiac Pathologies in Clinically Indicated Cardiac Computed Tomography with Emphasis on Status Before Pulmonary Vein Isolation

Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation

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