3D mapping versus cardiac computed tomography guided cryoballoon ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Varnavas ◽  
K De Schouwer ◽  
JP Abugattas ◽  
M Wolf ◽  
Y De Greef ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Radiation Exposure ◽  
Cardiac Computed Tomography ◽  
Fluoroscopy Time ◽  
Cryoballoon Ablation ◽  
3D Mapping ◽  
Procedural Time ◽  
The Mean ◽  
Patient Radiation Exposure

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac computed tomography (CCT) is an essential tool for an efficient ablation for atrial fibrillation. 3D mapping guided ablation could also deliver sufficient results in the setting of cryoballoon ablation (CBA) with additional advantages regarding total patient radiation exposure, fluoroscopy and procedural time. Purpose To compare the 3D mapping with the Achieve® catheter versus the CCT on the procedural characteristics and acute outcome during CBA. Methods Consecutive patients who underwent CBA with the second-generation cryoballoon (CB) were retrospectively enrolled from a single centre registry. Baseline and procedural characteristics of patients with pre-procedural CCT (CT-Group) were compared to those with peri-procedural 3D mapping (Ensite PrecisionTM ) with the 1st generation Achieve® catheter (3D-Group). Results A total of 696 patients were enrolled, 327 (47%) in the CT-Group and 369 (53%) in the 3D-Group. Baseline characteristics were comparable between the two groups. Similar pulmonary vein (PV) anatomical variations were identified in both groups and all PVs were acutely isolated. The mean CB temperature (T) at 60s, the nadir T, the time to PV isolation, the T of isolation and the mean thaw time did not differ significantly. However, the total procedural and fluoroscopy time were significantly shorter as well as the dose area product was significantly less  in the 3D-Group. Conclusion 3D mapping guided CBA using the Achieve® catheter is associated with significantly shorter fluoroscopy and procedural time and less patient radiation exposure. The anatomical acquisition of the PVs and the acute ablation outcome is non inferior to the CCT guided CBA. Procedural characteristics CT-Group n = 327 3D- Groupn = 369 p-value Paroxysmal AF 214 244 0.87 Total procedure time (min) 73.3 ± 23.1 65.1 ± 18.9 < 0.01 Fluoroscopy time (min) 14.9 ± 7.7 12.6 ± 7 0.02 DAP (Gy·cm2) 5924 ± 4991 4890 ± 3790 0.04 LCPV 37 41 1.00 RMPV 20 21 0.87 Mean T at 60s(oC) -41.9 ± 8.5 -40.6 ± 10.7 0.10 Mean nadir T(oC) -49.5 ± 6.4 -48.4 ± 7.8 0.18 Mean PVI time(s) 42.4 ± 26.3 38.1 ± 24.3 0.11 Mean PVI temperature(oC) -33.4 ± 11.6 -31.1 ± 22 0.16 Mean thaws time(s) 51.5 ± 20.5 51.8 ± 20.3 0.85

Abstract 13132: Reclassification of CHA 2 DS 2 -VASc Thromboembolic Risk by Coronary Calcifications on Cardiac Computed Tomography in Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Nicholas Chan ◽  
Paul C Cremer ◽  
Mohammed Kanj ◽  
Bryan Baranowski ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Cardiac Computed Tomography ◽  
Cleveland Clinic ◽  
Vascular Pathology ◽  
Thromboembolic Risk ◽  
Coronary Calcifications ◽  
The Mean ◽  
Gender Specific

Background: CHA 2 DS 2 -VASc is the most widely used thromboembolism risk score in patients with atrial fibrillation (AF). Cardiac computed tomography (CCT) routinely performed before or after pulmonary vein isolation (PVI) for AF rhythm control offers the opportunity to detect coronary calcifications (CAC) and this vascular pathology. We evaluated the frequency of CAC and the extent it affects the CHA 2 DS 2 -VASc and decision for anticoagulation for AF patients undergoing PVI. Methods: In 2014, 772 consecutive patients underwent PVI at Cleveland clinic, and 621 patients who had CCT within 1-year before or after PVI were studied. Relationships between CAC recorded as a binary variable with clinical characteristics and reclassification of CHA 2 DS 2 -VASc was analyzed. Results: Mean age was 63.1±9.8 years, 163 (26.2%) were females, 322 (51.9%) had paroxysmal AF and 264 (42.5%) having prior PVI. CAC was identified on CCT in 388 (62.5%) patients. Age was the only factor independently associated with CAC, odds ratio 1.02 (95% confidence interval 1.01-1.04), P=0.004. CAC increased the CHA 2 DS 2 -VASc in 306 (49.3%) patients, and the mean from 2.0±1.5 to 2.5±1.4 (Table). Using gender-specific cutpoints from the latest guidelines, 71 (11.4%) had CHA 2 DS 2 -VASc going from 0 to 1 in men or 1 to 2 in women (where anticoagulation may be considered), and 113 (18.2%) had CHA 2 DS 2 -VASc going from 1 to 2 in men or to 3 in women (where long-term anticoagulation is indicated). Conclusion: Almost two-thirds of patients undergoing PVI have CAC detectable on CCT, and after incorporating this information, long-term anticoagulation may or would be indicated in an additional 30% of the cohort. By assessing vascular pathology, CCT can play an important screening role for thromboembolic risk in AF patients incremental to clinical risk factors.

scholarly journals A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

2021 ◽  
Author(s):  
Andrew G. Yun ◽  
Marilena Qutami ◽  
Kory B. Dylan Pasko
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Hip Arthroplasty ◽  
Fluoroscopy Time ◽  
Lesser Trochanter ◽  
Total Hip ◽  
Preoperative Templating ◽  
The Mean ◽  
Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

Incidental Extracardiac Findings in Cardiac Computed Tomography Performed before Radiofrequency Ablation of Atrial Fibrillation

2011 ◽  
Vol 34 (12) ◽  
pp. 1665-1670 ◽  
Author(s):  
RAPHAËL PEDRO MARTINS ◽  
LUCIAN MURESAN ◽  
JEAN-MARC SELLAL ◽  
DAMIEN MANDRY ◽  
DENIS RÉGENT ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Cardiac Computed Tomography

scholarly journals Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement

2020 ◽  
Vol 47 (2) ◽  
pp. 78-85
Author(s):  
Kazuhiro Osawa ◽  
Rine Nakanishi ◽  
Indre Ceponiene ◽  
Negin Nezarat ◽  
William J. French ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Left Atrial Volume ◽  
Atrial Appendage ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Appendage Thrombus

Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03–1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05–1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.

scholarly journals Cardiac computed tomography: beyond ischemic heart disease and preTAVI studies. Experience during a year in a second level hospital

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
I Sanz Ortega ◽  
M Sadaba Sagredo ◽  
K Armendariz Tellitu ◽  
S Velasco Del Castillo ◽  
O Quintana Raczka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Angiography ◽  
Radiation Exposure ◽  
Spatial Resolution ◽  
Retrospective Studies ◽  
Imaging Techniques ◽  
Cardiac Computed Tomography ◽  
Mitral Annulus ◽  
Diagnostic Purpose ◽  
Cardiac Procedures

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac disease is generally evaluated by non-ionizing imaging exams, as echocardiogram or magnetic resonance (MRI) and cardiac computed tomography (cCT) is seldom performed due to radiation concerns, but this exam has some advantages as better spatial resolution or better assessment of calcifications. Depending on different cardiac procedures, radiation exposure to the patients varies. Published values ranged from 4 mSv approx. for coronary angiography alone to 15 mSv approx. if stenting and ventriculography are added. Apart from coronary angiography, cCT is usually performed to plan transaortic valve implantation (TAVI) but other indications exit. Methods we reviewed cCT performed during a year and selected those not performed to assess coronary stenosis or previous to TAVI procedure. Results There were 18 exams, 50% women, mean age 62.8 years (range 17 to 82). There were no inconclusive exams. There were 10 exams with diagnostic purpose, not for measuring different structures. Among them, suspected diagnosis was confirmed in 2 cases. Reasons to choose cCT were: better assessment of calcium (6 cases), better spatial resolution (11), contraindications to MRI (3: 1 due to claustrophobia, 2 due to intracardiac device). 3 exams had 2 reasons (better spatial resolution+ assessment of calcium). 4 exams were performed without contrast, only to assess calcification: 1 case the pericardium, 3 cases the aortic valve. In the rest, contrast was used, assessing coronary anatomy as well in 5 of them. Among them, calcification was also assessed in other 2 cases (pericardium in constrictive pericarditis and mitral annulus in a woman with previous coronary artery by-pass grafting in whom a new mitral intervention was planned). Mean Radiation exposure was 5.5 mSv (range 0.3 to 15.3). There were 9 prospective cases (4 women), with a mean age of 61.6 years (17 to 82 years). Radiation exposure was 1.9 mSv (0.3 to 5.9). Mean age in retrospective studies was 63.8 years (53 to 81). 5 women underwent a retrospective study. Radiation exposure in retrospective studies was 8.7 mSv (3.9 to 15.3). There were no complications. We can see images from the prospective and retrospective studies in figures 1 and 2 respectively. Conclusions Although is seldom performed, cCT can be used safely to assess different cardiac structures. In different cases in which other imaging techniques is not enough, cCT is a good option to evaluate different structures or ventricular function. Several structures can be assessed in the same exploration.

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