Intra-procedural imaging of the left atrium and pulmonary veins with rotational angiography: a comparison of anatomy obtained by pre-procedural cardiac computed tomography and trans-thoracic echocardiography

Abstract

This study evaluated the feasibility and accuracy of three-dimensional rotational angiography (3DRA) to determine the anatomy of the left atrium (LA) and pulmonary veins (PVs) compared with cardiac computed tomography (CCT) and trans-thoracic echocardiography (TTE). One hundred two patients (56.1 ± 9.9 years, 86 males) with an indication for atrial fibrillation ablation were prospectively enrolled. Intra-procedural 3DRA was performed with power injected contrast medium (20 cc/s for 4 s, 240°) in the LA. 3DRA images of the LA and PVs were assessed qualitatively and then compared quantitatively. LA volume measured by 3DRA, CCT and TTE were compared. The majority of 3DRA acquisitions were optimal in delineating the right-side LA-PV (95 % for right superior PV and 96 % for right inferior PV) and left inferior PV anatomy (91 %), whereas it was optimal in only 63 % of left superior PV and 73 % of the LA appendage. The circumferences of PV ostia identified by 3DRA and CCT were correlated in four PVs (r = 0.57 for right superior PV, r = 0.67 for right inferior PV, r = 0.60 for left superior PV, and r = 0.52 for left inferior PV, p < 0.001). The mean LA volume measured by 3DRA (120 ± 32 mL) was greater than that found by CCT (109 ± 35 mL) or TTE (64 ± 23 mL), but the 3DRA LA volume measurements correlated well with those of CCT (r = 0.83, p < 0.001) and TTE (r = 0.69, p < 0.001). Intra-procedural 3DRA provided anatomical accuracy of LA and PVs comparable to those of CCT. However, optimal delineation of the left superior PV and LA appendage was limited. The LA volume determined by 3DRA was well correlated with those of CCT and TTE, despite different absolute values of each.

Left Atrial Appendage Closure Devices

“…17 Measurements of the LAA orifice diameters are increasingly essential to ensure the correct sizing and deployment of the occlusion device to optimize effectiveness and minimize complications. 18 The best imaging modalities for performing this measurement are cardiac computed tomography (CCT), 19 cardiac magnetic resonance (CMR), 20 and 3-D TEE, 21 which, as expected, provides more precise values than 2-D TEE. 22 It is worth mentioning that measuring LAA length and LAA ostium diameter by 2-D TEE 23 as demonstrated by the CUTE-CV study, in which a contrast agent was utilized.…”

“…Consequently, cardiac imaging has become of paramount importance for LAA anatomical characterization and device placement 17. Measurements of the LAA orifice diameters are increasingly essential to ensure the correct sizing and deployment of the occlusion device to optimize effectiveness and minimize complications 18. The best imaging modalities for performing this measurement are cardiac computed tomography (CCT),19 cardiac magnetic resonance (CMR),20 and 3-D TEE,21 which, as expected, provides more precise values than 2-D TEE 22.…”

Left atrial appendage closure devices for cardiovascular risk reduction in atrial fibrillation patients

“…Cardiac imaging is of primary importance for LAA anatomical characterization, device size choice, ruling out LAA thrombus before the procedure, and minimizing complications. 27,28 Currently, the best preprocedural imaging modalities are cardiac computed tomography (CCT), 29 cardiac magnetic resonance, 30 and three-dimensional TEE. 31 Two-and three-dimensional TEE are commonly used during LAA closure procedure.…”

Cardiovascular imaging 2013 in the International Journal of Cardiovascular Imaging

“…Park et al [3] investigated the feasibility and accuracy of 3D rotational angiography (3DRA) to determine the anatomy of the left atrium (LA) and pulmonary veins (PVs) compared with cardiac computed tomography (CCT) and trans-thoracic echocardiography (TTE) in a population of 102 patients. They concluded that this intra-procedural imaging resulted in 3DRA LA volumes (120 ± 32 mL) being greater than those found by CCT (109 ± 35 mL) or TTE (64 ± 23 mL), although with high correlations.…”