Intraprocedural Imaging of Left Atrium and Pulmonary Veins with Rotational Angiography: A Comparison of Anatomy Obtained by Cardiac Computed Tomography

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Background: Contrast-enhanced three-dimensional rotational angiography (3DRA) is a novel method for three-dimensional reconstruction of the left atrium (LA) and pulmonary veins (PVs) during catheter ablation for atrial fibrillation (AF). The purpose of this study was to assess the feasibility and accuracy of anatomy obtained by 3DRA compared with computed tomography (CT). Methods: Patients with an indication for AF ablation were included. Contrast enhanced cardiac CT was performed within 24 hours prior to ablation. Intraprocedural 3DRA was performed with power injected contrast medium (20 cc per 1 sec for 4 sec, 240 degree angle). We compared LA volume and circumferences of four PVs obtained from each imaging method. Results: Total 16 patients (mean age: 55±9.3 year old) were prospectively included. Five patients were paroxysmal, while 11 patients were persistent. LA volume measured by 3DRA and CT was well correlated (r=0.94, p<0.00). The circumference of four PVs for each imaging method was well correlated in left superior PV (r=0.62) and right superior PV (r=0.52) (p<0.05) but was less in right inferior PV (r=0.39) and left inferior PV (r=0.45), respectively. (p=NS). Conclusions: Intraprocedural imaging, 3DRA provides anatomical accuracy of the LA and superior PVs comparable to cardiac CT. However, special attention is required to assess inferior PVs using 3DRA.