The Suitable Timing of Contrast Medium before Three-Dimensional Rotational Angiography of the Left Atrium (LA) for the Patients with Atrial Fibrillation (AF)

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Background: Three-dimensional rotational angiography or atriography (3DATG) is useful for AF ablation. However the suitable timing of contrast injection into the right atrium is unknown. Therefore, we investigated the usefulness of the time from the injection to the left ventricle filled with contrast medium (TLV) to predict the timing of contrast delivery for the 3DATG. Method: From August 2010 to March 2011, we measured the TLV in 48 patients with arrhythmia. For the measurement of TLV, a pigtail catheter was introduced into right atrium and 20 milliliters of contrast medium was injected in one second for the test injection. Result: The average of TLV was 9.2±2.4 sec (range 4.5–17.3 sec). Stepwise multiple regression analysis revealed that gender, BNP level, left ventricular ejection fraction (LVEF) and LA dimension remained significantly associated with TLV (r=0.519, 0.657, 0.698, 0.730 respectively, p<0.01). Good images of LA were obtained in the latest 28 patients who underwent the 3DATG just after the TLV for AF ablation. Conclusion: The determinant factors of LVT were gender, BNP level, LVEF and LA dimension. Since there remains large variation in TLV, the measurement of TLV is useful for the good image of LA in 3DATG for AF ablation.