Reproducibility analysis of the computerized tomography angiography–derived left atrial wall thickness maps

Colomer, Anna Vallès; Forcada, Barbara Rubio; Soto‐Iglesias, David; Planes, Xavi; Trueba, Ramón; Terés, Cheryl; Penela, Diego; Berruezo, Antonio; Serra, Luis M.; Ventura, R.

doi:10.1007/s10840-023-01472-5

Cited by 5 publications

(5 citation statements)

References 12 publications

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“… 20 The reproducibility agreement of LAWT maps derived by the described semi-automatic threshold-based segmentation was also recently analysed. 21 Results of the analysis reported a colour agreement between LAWT maps of 95.5% and 92.9% intra- and inter-observer, respectively; the titration of the AI showed an average difference lower than 25 units in all cases. For all analyses, the concordance increased with user experience.…”

Section: Methodsmentioning

confidence: 78%

Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation

et al. 2023

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Aims Pulmonary vein (PV) antrum isolation proved to be effective for treating persistent atrial fibrillation (PeAF). We sought to investigate the results of a personalized approach aimed at adapting the ablation index (AI) to the local left atrial wall thickness (LAWT) in a cohort of consecutive patients with PeAF. Methods and results Consecutive patients referred for PeAF first ablation were prospectively enrolled. The LAWT three-dimensional maps were obtained from pre-procedure multidetector computed tomography and integrated into the navigation system. Ablation index was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the PV antrum. A total of 121 patients (69.4% male, age 64.5 ± 9.5 years) were included. Procedure time was 57 min (IQR 50–67), fluoroscopy time was 43 s (IQR 20–71), and radiofrequency (RF) time was 16.5 min (IQR 14.3–18.4). The median AI tailored to the local LAWT was 387 (IQR 360–410) for the anterior wall and 335 (IQR 300–375) for the posterior wall. First-pass PV antrum isolation was obtained in 103 (85%) of the right PVs and 103 (85%) of the left PVs. Median LAWT values were higher for PVs without first-pass isolation as compared to the whole cohort (P = 0.02 for left PVs and P = 0.03 for right PVs). Recurrence-free survival was 79% at 12 month follow-up. Conclusion In this prospective study, LAWT-guided PV antrum isolation for PeAF was effective and efficient, requiring low procedure, fluoroscopy, and RF time. A randomized trial comparing the LAWT-guided ablation with the standard of practice is in progress (ClinicalTrials.gov, NCT05396534).

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Section: Methodsmentioning

confidence: 78%

Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation

et al. 2023

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“… 16 To date, however, no study have assessed in vivo the extent of myocardial fat infiltration at the level of LA. Based on recent demonstration that the epicardial aspect of the LA myocardium might be easily and reproducibly segmented through computerized tomography angiography (CTA) imaging, 17 we here report, for the first time, that adequate post-processing of MDCT LA images allows to construct LA inFAT maps and to accurately quantify the degree of fat infiltration in the LA. Our data suggest that in patients who do not present a significantly remodelled left atrium (the study only included patients with a LA diameter >42 mm), the degree of LA fatty infiltration is associated with an increased probability of AF.…”

Section: Discussionmentioning

confidence: 99%

“…Altogether, these results suggest that LAWT measurements are reproducible. 17 Subsequently, LAWT was automatically computed at each point as the distance between each endocardial point and its projection to the epicardial shell and displayed as a colour-coded 3D map (red < 1 mm, 1 mm ≤ yellow < 2 mm, 2 mm ≤ green < 3 mm, 3 mm ≤ blue < 4 mm, and purple ≥ 4 mm). 3D inFAT maps were generated using a threshold-based segmentation of the volume between the endocardial and the epicardial LA shells.…”

Section: Methodsmentioning

confidence: 99%

“…We recently demonstrated that pre-procedural MDCT-derived images can be post-processed and the endocardial and epicardial aspects of the atrial myocardium can be easily and reproducibly segmented, 17 with the potential to derive 3D left atrial wall thickness (LAWT) maps which can be used for a personalized AF ablation approach. 18 , 19 Aim of the present study is to evaluate the feasibility of creating 3D LA inFAT maps and to compare the extent of inFAT between patients without AF history, with paroxysmal, and with persistent AF.…”

Section: Introductionmentioning

confidence: 99%

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Assessing left atrial intramyocardial fat infiltration from computerized tomography angiography in patients with atrial fibrillation

Saglietto,

Falasconi,

Soto-Iglesias

et al. 2023

Europace

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Aims Epicardial adipose tissue might promote atrial fibrillation (AF) in several ways, including infiltrating the underlying atrial myocardium. However, the role of this potential mechanism has been poorly investigated. The aim of this study is to evaluate the presence of left atrial (LA) infiltrated adipose tissue (inFAT) by analysing multi-detector computer tomography (MDCT)-derived three-dimensional (3D) fat infiltration maps and to compare the extent of LA inFAT between patients without AF history, with paroxysmal, and with persistent AF. Methods and results Sixty consecutive patients with AF diagnosis (30 persistent and 30 paroxysmal) were enrolled and compared with 20 age-matched control; MDCT-derived images were post-processed to obtain 3D LA inFAT maps for all patients. Volume (mL) and mean signal intensities [(Hounsfield Units (HU)] of inFAT (HU −194; −5), dense inFAT (HU −194; −50), and fat-myocardial admixture (HU −50; −5) were automatically computed by the software. inFAT volume was significantly different across the three groups (P = 0.009), with post-hoc pairwise comparisons showing a significant increase in inFAT volume in persistent AF compared to controls (P = 0.006). Dense inFAT retained a significant difference also after correcting for body mass index (P = 0.028). In addition, more negative inFAT radiodensity values were found in AF patients. Regional distribution analysis showed a significantly higher regional distribution of LA inFAT at left and right superior pulmonary vein antra in AF patients. Conclusion Persistent forms of AF are associated with greater degree of LA intramyocardial adipose infiltration, independently of body mass index. Compared to controls, AF patients present higher LA inFAT volume at left and right superior pulmonary vein antra.

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“…Data on the high reproducibility agreement of the segmentation method of LAWT maps have been reported previously. 15 MATLAB customized software was used for maps analysis and LAWT calculation; the circumference of both left PVs (LPVs) and right PVs (RPVs) antra was divided in an eight-segment model, 8 as previously described.…”

Section: Methodsmentioning

confidence: 99%

Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial

Falasconi,

Penela,

Soto-Iglesias

et al. 2024

Europace

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Aims Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) using very high-power short-duration (vHPSD) radiofrequency (RF) ablation proved to be safe and effective. However, vHPSD applications result in shallower lesions that might not be always transmural. Multidetector computed tomography-derived left atrial wall thickness (LAWT) maps could enable a thickness-guided switching from vHPSD to the standard-power ablation mode. The aim of this randomized trial was to compare the safety, the efficacy, and the efficiency of a LAWT-guided vHPSD PVI approach with those of the CLOSE protocol for PAF ablation (NCT04298177). Methods and results Consecutive patients referred for first-time PAF ablation were randomized on a 1:1 basis. In the QDOT-by-LAWT arm, for LAWT ≤2.5 mm, vHPSD ablation was performed; for points with LAWT > 2.5 mm, standard-power RF ablation titrating ablation index (AI) according to the local LAWT was performed. In the CLOSE arm, LAWT information was not available to the operator; ablation was performed according to the CLOSE study settings: AI ≥400 at the posterior wall and ≥550 at the anterior wall. A total of 162 patients were included. In the QDOT-by-LAWT group, a significant reduction in procedure time (40 vs. 70 min; P < 0.001) and RF time (6.6 vs. 25.7 min; P < 0.001) was observed. No difference was observed between the groups regarding complication rate (P = 0.99) and first-pass isolation (P = 0.99). At 12-month follow-up, no significant differences occurred in atrial arrhythmia-free survival between groups (P = 0.88). Conclusion LAWT-guided PVI combining vHPSD and standard-power ablation is not inferior to the CLOSE protocol in terms of 1-year atrial arrhythmia-free survival and demonstrated a reduction in procedural and RF times.

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Reproducibility analysis of the computerized tomography angiography–derived left atrial wall thickness maps

Cited by 5 publications

References 12 publications

Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation

Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation

Assessing left atrial intramyocardial fat infiltration from computerized tomography angiography in patients with atrial fibrillation

Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial

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