Europace Advance Access originally published online on December 3, 2008
Europace 2009 11(1):35-41; doi:10.1093/europace/eun311
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Ablation: Imaging
A new approach for contrast-enhanced X-ray imaging of the left atrium and pulmonary veins for atrial fibrillation ablation: rotational angiography during adenosine-induced asystole
1 Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; 2 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
Aims: Atrial fibrillation ablation is a complex procedure that requires detailed anatomic information about left atrium (LA) and pulmonary veins (PVs). The goal of this study was to test rotational angiography of the LA during adenosine-induced asystole as an imaging tool in patients undergoing atrial fibrillation ablation.
Methods and results: Seventy patients with paroxysmal or persistent atrial fibrillation undergoing PV isolation were included. After transseptal puncture, adenosine (30 mg) was given intravenously, and during atrioventricular block, contrast medium was directly injected in the LA; a rotational angiography was performed (right anterior oblique 55° to left anterior oblique 55°). Rotational angiography images were assessed qualitatively in all patients and quantitatively in 45 patients in comparison with computed tomography (CT) images. The majority of rotational angiography imaging data (94%) were deemed at least ‘useful’ in delineating the LA–PV anatomy. The so-called ‘ridge’ between left superior PV and left atrial appendage was delineated in 90% of the patients. All accessory PVs were independently identified by rotational angiography and CT. A blinded quantitative comparison of PV ostial diameters showed an excellent correlation between rotational angiography and CT measurements (r > 0.90 for all PVs). No serious adverse effects occurred in association with adenosine.
Conclusion: Intra-procedural contrast-enhanced rotational angiography of the LA–PV during adenosine-induced asystole is feasible and provides anatomical information of high diagnostic value for atrial fibrillation ablation.
Key Words: Atrial fibrillation ablation, Rotational angiography, Adenosine, Pulmonary vein ostia
* Corresponding author. Tel: +49 30 4593 2436; fax: +49 30 4593 2438. E-mail address: kriatselis{at}dhzb.de
The first two authors contributed equally to this work.
Manuscript submitted 15 July 2008. Accepted after revision 22 October 2008.
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