CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast to guide preprocedural planning before LA ablation. CT Chest Without IV Contrast A single prospective study of 50 patients evaluated with unenhanced chest CT found no statistically significant difference in procedural times and ablation success rate [16]. This is limited by the population size and paucity of additional supporting data. Integration of unenhanced CT with electroanatomic mapping cannot be adequately performed [16], and evaluation for contraindications such as thrombus is not possible. CT Heart Function and Morphology With IV Contrast ECG-gated cardiac multidetector CT (MDCT) can assess left atrium, LAA, and pulmonary venous anatomy. In a study including 1,040 consecutive patients who underwent pulmonary vein catheter ablation, cardiovascular anatomic variants were identified on gated-CT in 18.7% of cases [5]. For patients undergoing repeat ablation procedures, CT can assess sites of pulmonary vein stenosis or occlusion caused by a prior procedure. It also provides information on adjacent thoracic structures, including the esophagus, and facilitates electroanatomic mapping for preprocedural planning for ablation. Left Atrial Procedures in Atrial Fibrillation CT heart has also been evaluated in assessing thrombi before various LA procedures. With specific regard to the preablation setting, the specificity and negative predictive value (NPV) of a single acquisition CT (without delayed or prone imaging) have been reported to be 88% and 100%, respectively, based on a study of 51 patients when compared with transesophageal echocardiography (TEE) [17]. The diagnostic accuracy of CT for thrombus can be further improved by using a delayed phase or prone position [18].
Preprocedural Planning for Left Atrial Procedures in Atrial Fibrillation. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast to guide preprocedural planning before LA ablation. CT Chest Without IV Contrast A single prospective study of 50 patients evaluated with unenhanced chest CT found no statistically significant difference in procedural times and ablation success rate [16]. This is limited by the population size and paucity of additional supporting data. Integration of unenhanced CT with electroanatomic mapping cannot be adequately performed [16], and evaluation for contraindications such as thrombus is not possible. CT Heart Function and Morphology With IV Contrast ECG-gated cardiac multidetector CT (MDCT) can assess left atrium, LAA, and pulmonary venous anatomy. In a study including 1,040 consecutive patients who underwent pulmonary vein catheter ablation, cardiovascular anatomic variants were identified on gated-CT in 18.7% of cases [5]. For patients undergoing repeat ablation procedures, CT can assess sites of pulmonary vein stenosis or occlusion caused by a prior procedure. It also provides information on adjacent thoracic structures, including the esophagus, and facilitates electroanatomic mapping for preprocedural planning for ablation. Left Atrial Procedures in Atrial Fibrillation CT heart has also been evaluated in assessing thrombi before various LA procedures. With specific regard to the preablation setting, the specificity and negative predictive value (NPV) of a single acquisition CT (without delayed or prone imaging) have been reported to be 88% and 100%, respectively, based on a study of 51 patients when compared with transesophageal echocardiography (TEE) [17]. The diagnostic accuracy of CT for thrombus can be further improved by using a delayed phase or prone position [18].