This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. For the purposes of the document, CTA chest may be performed with electrocardiogram (ECG) gating, triggering, high pitch dual source acquisition, or nongated acquisition depending on site technology and experience. This is in distinction to CT heart, which is routinely performed with ECG gating and is often limited in z-axis to only cover the heart. Similarly, MR angiography (MRA) chest may be an ECG-gated or nongated acquisition and may be performed with or without contrast. The 3-D reconstructions and renderings are an essential element for MRA. Discussion of Procedures by Variant Variant 1: Adult. Atrial fibrillation, atrial tachycardia, or atypical atrial flutter. Preprocedural planning prior to left atrial ablation. Arteriography Coronary Invasive coronary arteriography provides assessment of coronary artery disease. There is no relevant literature to support the use of routine coronary arteriography to guide preprocedural planning before LA ablation procedure. Catheter Venography Pulmonary Catheter venography provides assessment of the pulmonary veins. There is little evidence in the literature supporting the use of catheter venography for routine preprocedural planning for atrial arrhythmia ablation. One retrospective review evaluated periprocedural 3-D rotational angiography in 547 consecutive patients undergoing ablation via direct contrast injection into either the right or left atrium, with or without simultaneous oral contrast administration for esophageal mapping [15]. With the availability of electroanatomic mapping systems, there is no added benefit or literature supporting the use of catheter venography during atrial arrhythmia ablation. CT Chest With IV Contrast There is no relevant literature to support the use of CT chest with intravenous (IV) contrast to guide preprocedural planning before LA ablation.
Preprocedural Planning for Left Atrial Procedures in Atrial Fibrillation. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. For the purposes of the document, CTA chest may be performed with electrocardiogram (ECG) gating, triggering, high pitch dual source acquisition, or nongated acquisition depending on site technology and experience. This is in distinction to CT heart, which is routinely performed with ECG gating and is often limited in z-axis to only cover the heart. Similarly, MR angiography (MRA) chest may be an ECG-gated or nongated acquisition and may be performed with or without contrast. The 3-D reconstructions and renderings are an essential element for MRA. Discussion of Procedures by Variant Variant 1: Adult. Atrial fibrillation, atrial tachycardia, or atypical atrial flutter. Preprocedural planning prior to left atrial ablation. Arteriography Coronary Invasive coronary arteriography provides assessment of coronary artery disease. There is no relevant literature to support the use of routine coronary arteriography to guide preprocedural planning before LA ablation procedure. Catheter Venography Pulmonary Catheter venography provides assessment of the pulmonary veins. There is little evidence in the literature supporting the use of catheter venography for routine preprocedural planning for atrial arrhythmia ablation. One retrospective review evaluated periprocedural 3-D rotational angiography in 547 consecutive patients undergoing ablation via direct contrast injection into either the right or left atrium, with or without simultaneous oral contrast administration for esophageal mapping [15]. With the availability of electroanatomic mapping systems, there is no added benefit or literature supporting the use of catheter venography during atrial arrhythmia ablation. CT Chest With IV Contrast There is no relevant literature to support the use of CT chest with intravenous (IV) contrast to guide preprocedural planning before LA ablation.