The Clinical Value of Nongated Dual‐Source Computed Tomography in Atrial Fibrillation Catheter Ablation

Iwayama, Tadateru; Arimoto, Takanori; Ishigaki, Daisuke; Hashimoto, Naoaki; Kumagai, Yu; Koyama, Yo; Kiribayashi, Nobuyuki; Netsu, Shunsuke; Nishiyama, Satoshi; Takahashi, Hiroki; Shishido, Tetsuro; Miyamoto, Takuya; Sato, Toshimitsu; Watanabe, Tetsu

doi:10.1111/jce.12826

Cited by 8 publications

(5 citation statements)

References 32 publications

(71 reference statements)

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“…In addition, the results of our study demonstrated better IQ, more integration success, and lower radiation dose for the ECG-gated high-pitch protocol than for the non-ECG-gated high-pitch protocol. This finding is in contrast to the observations by Iwayama et al (38). Larger samples are, however, required for a better evaluation.…”

Section: Discussioncontrasting

confidence: 95%

Left Atrial Mapping in Patients with Atrial Fibrillation: A Comparison Study of Image Quality and Radiation Dose Between High-Pitch Spiral CT Angiography and Retrospective ECG-Gated CT Angiography

Pooraliakbar¹,

Sadrabad²,

Emkanjoo³

et al. 2016

Arch Cardiovasc Imaging

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Background: Trying to reduce radiation exposure from cardiac imaging is mandatory while maintaining diagnostic image quality (IQ). Using a high-pitch spiral dual-source computed tomography (DSCT) protocol for left atrial (LA) mapping, we sought to determine IQ and radiation dose in patients with atrial fibrillation scheduled for radiofrequency ablation. Methods: Fifty-nine patients (29 women; mean age = 53 y) underwent CT angiography between 2013 and 2016: 26 patients with retrospective ECG-gated (classic) and 33 with high-pitch (Flash) protocols on a second-generation 128-DSCT system (SOMATOM Definition Flash). CT images of the LA were integrated into an electroanatomic system (NavX). Two independent blinded readers evaluated IQ using a 3-point scale and the LA contrast density. Dose-length product (DLP) was obtained from each patient protocol, and effective radiation dose (ERD) was calculated according to the European guideline for CT. Results: The rate of diagnostic IQ (score 3 or 2) was 87.9% for the flash group and 96.2% for the classic group, which was not significantly different between the 2 groups (P = 0.250). The results of objective IQ measurements showed that a central LA contrast density above 350 Hounsfield units (diagnostic) was present in 21 (80.8%) images in the classic group and 26 (78.8%) images in the flash group, which was not statistically different between the 2 groups (P = 0.850). There were significant differences (P < 0.001) in DLP and ERD between the 2 groups: the values were lower in high-pitch scan than in retrospective ECG-gated scan (151.30 ± 39.44 vs. 776.61 ± 243.63 and 2.11 ± 0.55 vs. 10.872 ± 3.41, respectively). Conclusions: High-pitch (Flash) DSCT is an acceptable CT angiography method for reducing radiation dose without compromising IQ for LA and pulmonary venous imaging in patients with atrial fibrillation.

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Section: Discussioncontrasting

confidence: 95%

Left Atrial Mapping in Patients with Atrial Fibrillation: A Comparison Study of Image Quality and Radiation Dose Between High-Pitch Spiral CT Angiography and Retrospective ECG-Gated CT Angiography

Pooraliakbar¹,

Sadrabad²,

Emkanjoo³

et al. 2016

Arch Cardiovasc Imaging

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“…DSCT improves the time resolution of synchronous cardiac scanning and proves that DSCT can successfully image the heart and coronary arteries at high heart rates and complex rhythms. In addition, the combination of DSCT and electrocardiogram gating technology quickly covers the heart, resulting in a reduction in radiation exposure compared to standard MDCT [ 42 , 43 ]. Due to the shortened examination time and reduced use of contrast agents, the safety for renal insufficiency patients has improved [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Left Atrial/Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Song,

Liu,

Shi

et al. 2023

Rev. Cardiovasc. Med.

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Background: This paper aimed to appraise the diagnostic precision of assorted methodologies to identify left atrial/left atrial appendage (LA/LAA) thrombus through a network meta-assessment. Methods: Methodologically, we conducted a comprehensive literature search across multiple databases. Utilizing the risk of bias tool from the Cochrane Collaboration, methodological quality of included studies was critically assessed and potential publication bias was examined via funnel plots. The subsequent data analysis was executed using Stata software, with the most efficacious diagnostic modalities being determined based on cumulative ranking curve (SUCRA) values. Results: We scrutinized a sum of 18 papers, comprising 4102 subjects and utilizing 10 different diagnostic techniques. The hierarchical results derived from the network meta-analysis indicated that in regards to sensitivity, the dual-source cardiac computed tomography (DSCT) was superior (with a SUCRA value of 71.7%), it was succeeded by 3-minute delayed cardiac computed tomography (CCT) (scoring 66.8%), which surpassed the transesophageal echocardiography (TEE) (holding a SUCRA value of 57.5%). In terms of specificity, DSCT was the best (SUCRA value of 84.3%), followed by three dimensional (3D) cardiac magnetic resonance imaging (3D-CMRI) (SUCRA value of 78.0%), which was better than TEE (SUCRA value of 66.6%). In terms of positive likelihood ratio (PLR), 6-minute delayed CCT (SUCRA value of 85.6%) was superior to 3-minute delayed CCT (SUCRA value of 80.1%), both of which were superior to TEE (SUCRA value of 69.1%). DSCT (SUCRA value of 89.3%) had the best negative likelihood ratio (NLR), while DSCT (SUCRA value of 79.9%) had the highest accuracy. Conclusions: This study demonstrated that DSCT outperformed TEE in sensitivity, specificity, NLR, and accuracy in identifying thrombus of LA/LAA among patients suffering from atrial fibrillation. Our conclusion is that DSCT is the best in diagnosing LA/LAA. In addition, 3D-CMRI and 3-minute delayed CCT are expected to replace TEE.

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“…Thus, in the present study, we described low-dose CT scanning protocols that can be implemented on the standard on-site hospital CT scanner for pre-RFA imaging of LA and EAM-CT co-registration and fusion. Previously, various CT protocols have been developed, including non-ECG gated scanning, retrospective and prospective ECG-triggered axial scanning (Step & Shoot Cardiac) [20,21], dual-source high-pitch spiral scanning [22,23], adaptive statistical iterative reconstruction algorithm (ASIR; GE Healthcare, Milwaukee, WI, USA) and model-based iterative reconstruction (MBIR) technology [24]. The ECG-gated 64-row CT generates a relatively high radiation dose (13.4 mSv) requiring substantial contrast volume for adequate LA image quality.…”

Section: Discussionmentioning

confidence: 99%

Reduced Radiation Exposure Protocol during Computer Tomography of the Left Atrium Prior to Catheter Ablation in Patients with Atrial Fibrillation

et al. 2022

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(1) Background: Computer tomography (CT) is an imaging modality used in the pre-planning of radiofrequency catheter ablation (RFA) procedure in patients with cardiac arrhythmias. However, it is associated with a considerable ionizing radiation dose for patients. This study aims to develop and validate low-dose CT scanning protocols of the left atrium (LA) for RFA guidance. (2) Methods: 68 patients scheduled for RFA of atrial fibrillation were sequentially assigned to four groups of ECG-gated scanning protocols, based on the set tube current (TC): Group A (n = 20, TC = 33 mAs), Group B (n = 18, TC = 67 mAs), Group C (n = 10, TC = 135 mAs), and control Group D (n = 20, TC = 600 mAs). We used a 256-row multidetector CT with body weight-dependent tube voltage of 80 kVp (<70 kg), 100 kVp (70–90 kg), and 120 kVp (>90 kg). We evaluated scanning parameters including radiation dose, total scanning procedure time and signal-to-noise ratio (SNR). (3) Results: The average effective radiation dose (ED) was lower in Group A in comparison to Group B, C and D (0.83 (0.76–1.10), 1.55 (1.36–1.67), 2.91 (2.32–2.96) and 9.35 (8.00–10.04) mSv, p < 0.05). The total amount of contrast media was not significantly different between groups. The mean SNR was 6.5 (5.8–7.3), 7.1 (5.7–8.2), 10.8 (10.1–11.3), and 12.2 (9.9–15.7) for Group A, B, C and D, respectively. The comparisons of SNR in group A vs. B and C vs. D were without significant differences. (4) Conclusions: Optimized pre-ablation CT scanning protocols of the LA can reduce an average ED by 88.7%. Three dimensional (3D) models created with the lowest radiation protocol are useful for the integration of electro-anatomic-guided RFA procedures.

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The Clinical Value of Nongated Dual‐Source Computed Tomography in Atrial Fibrillation Catheter Ablation

Abstract: Nongated 128-DSCT provides sufficient image quality to allow integrated EAM while exposing the patient to less contrast media, lower radiation doses, and shorter CT scan durations.

Cited by 8 publications

References 32 publications

Left Atrial Mapping in Patients with Atrial Fibrillation: A Comparison Study of Image Quality and Radiation Dose Between High-Pitch Spiral CT Angiography and Retrospective ECG-Gated CT Angiography

Left Atrial Mapping in Patients with Atrial Fibrillation: A Comparison Study of Image Quality and Radiation Dose Between High-Pitch Spiral CT Angiography and Retrospective ECG-Gated CT Angiography

Diagnostic Accuracy of Left Atrial/Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Reduced Radiation Exposure Protocol during Computer Tomography of the Left Atrium Prior to Catheter Ablation in Patients with Atrial Fibrillation

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