Efficacy of 3D Pulmonary Vein Image Acquired Non-Enhanced MDCT in Patients with Chronic Kidney Disease without Dialysis who Underwent Atrial Fibrillation Ablation

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Introduction: Precise anatomical images of pulmonary vein (PV) and left atrium (LA) are essential for atrial fibrillation (AF) ablation. These images are usually acquired with enhanced MDCT using contrast medium (CM). However, CM is relatively contra-indication for patients with chronic kidney disease (CKD). Aim: To access whether AF ablation could be possible with both only 3D-PV/LA images acquired with non-enhanced MDCT and without using CM during AF ablation procedure. Patients and Methods: We compared the AF ablation results between consecutive 15 patients with CKD who underwent AF ablation (group 1) and 30 patients without CKD who underwent AF ablation (group 2). 3D-PV/LA images were acquired with non-enhanced MDCT in group 1, and with enhanced MDCT in group 2. In group 1, AF ablation was performed mainly with fluoroscopic guidance. In group 2, AF ablation was performed with 3D electroanatomical mapping system (CARTO-XP or EnSite NavX). Results: Procedure and fluoroscopic time were relatively longer in group 1 (136±24 min vs 115±18 min, P=0.09 and 32±9 min vs 25±7 min, P=0.12, respectively). However, there were no significant differences in ablation success (100% vs 100%), complications (0% vs 0%) and AF recurrence rate (24% vs 22%) after 3 months AF ablation. Conclusions: AF ablation could be possible in patients with CKD using 3D-PV/LA image acquired with only non-enhanced MDCT without using CM.