Variant 2: Dyspnea due to suspected cardiac arrhythmia. Ischemia excluded. Initial imaging. Arteriography Coronary with Ventriculography There is no relevant literature to support the use of arteriography coronary with ventriculography for the evaluation of dyspnea due to suspected cardiac arrhythmia, ischemia excluded. CT Coronary Calcium There is no relevant literature to support the use of CT coronary calcium for the evaluation of dyspnea due to suspected cardiac arrhythmia, ischemia excluded. CT can provide a precise regional anatomic survey for pre- and intraprocedural guidance of catheter ablation [66], with potential ablation targets notably located within 1 cm of critical structures such as coronary arteries and phrenic nerve in 35 (80%) and 18 (37%) patients, respectively [68]. CT also provides robust anatomic delineation of pulmonary vein and left atrial appendage anatomy [28] for both planning and follow-up of pulmonary vein ablation as well as left atrial appendage occlusion for atrial fibrillation treatment. Measured attenuation of epicardial fat has shown to be a predictor of electrophysiologic properties of the adjacent left atrium in patients with atrial fibrillation [69]. CTA Coronary Arteries There is no relevant literature to support the use of CTA coronary arteries for the evaluation of dyspnea due to suspected cardiac arrhythmia, ischemia excluded. FDG-PET/CT Heart Patients may benefit from PET imaging for scar identification and for prediction of ventricular arrhythmia and sudden cardiac death. Full thickness myocardial scarring has shown strong association with major arrhythmic events after accounting for age, sex, cardiovascular risk factors, beta-blocker therapy, and resting LV ejection fraction Morphologic analysis of fibrotic scarring in nonischemic dilated cardiomyopathy has shown promise in prediction of electrophysiologic impact [77].
Dyspnea Suspected Cardiac Origin Ischemia Already Excluded . Variant 2: Dyspnea due to suspected cardiac arrhythmia. Ischemia excluded. Initial imaging. Arteriography Coronary with Ventriculography There is no relevant literature to support the use of arteriography coronary with ventriculography for the evaluation of dyspnea due to suspected cardiac arrhythmia, ischemia excluded. CT Coronary Calcium There is no relevant literature to support the use of CT coronary calcium for the evaluation of dyspnea due to suspected cardiac arrhythmia, ischemia excluded. CT can provide a precise regional anatomic survey for pre- and intraprocedural guidance of catheter ablation [66], with potential ablation targets notably located within 1 cm of critical structures such as coronary arteries and phrenic nerve in 35 (80%) and 18 (37%) patients, respectively [68]. CT also provides robust anatomic delineation of pulmonary vein and left atrial appendage anatomy [28] for both planning and follow-up of pulmonary vein ablation as well as left atrial appendage occlusion for atrial fibrillation treatment. Measured attenuation of epicardial fat has shown to be a predictor of electrophysiologic properties of the adjacent left atrium in patients with atrial fibrillation [69]. CTA Coronary Arteries There is no relevant literature to support the use of CTA coronary arteries for the evaluation of dyspnea due to suspected cardiac arrhythmia, ischemia excluded. FDG-PET/CT Heart Patients may benefit from PET imaging for scar identification and for prediction of ventricular arrhythmia and sudden cardiac death. Full thickness myocardial scarring has shown strong association with major arrhythmic events after accounting for age, sex, cardiovascular risk factors, beta-blocker therapy, and resting LV ejection fraction Morphologic analysis of fibrotic scarring in nonischemic dilated cardiomyopathy has shown promise in prediction of electrophysiologic impact [77].