In a small study of 70 patients, the specificity and positive predictive value of CT increased from 84% and 15% to 100% and 100%, respectively, by adding a delayed phase [19]. The high NPV can be used to decrease the usefulness of TEE, so that it is selectively used only when CT is positive. Hong et al [20] found that patients who underwent cardiac MDCT followed by routine TEE had no significant difference in periprocedural stroke incidence when compared with selective TEE (0.2% incidence in each group, P > . 99); the sensitivity and NPV of CT were 100% and 100%, respectively, in this study. This strategy of selective use of TEE was also assessed during the COVID-19 pandemic, and the study showed no significant difference in periprocedural thromboembolic events between routine TEE versus selective use of TEE guided by CT (0% versus 0.4%, P = . 33, n = 637) [21]. Cardiac CT can assess LA size, which may help guide patient management as increased LA volume is an independent predictor of arrhythmia recurrence (n = 103; hazard ratio [HR], 1.011/mL; 95% confidence interval [CI], 1.003-1.020; P = . 002) [22]. CTA Coronary Arteries With IV Contrast CTA coronary arteries is used to assess coronary arterial disease. There is no relevant literature supporting the routine use of CTA coronary arteries with IV contrast to guide preprocedural planning before LA ablation. This can also be technically challenging due to irregular heart rhythm in these patients. Although not routinely recommended, if the specific clinical scenario requires coronary arterial evaluation in addition to preablation planning, the study may be performed as a CTA coronary examination and left atrium and pulmonary veins can be assessed simultaneously. MRA Chest Without and With IV Contrast MRA without and with IV contrast can assess LA size, pulmonary venous anatomy, and thrombus.
Preprocedural Planning for Left Atrial Procedures in Atrial Fibrillation. In a small study of 70 patients, the specificity and positive predictive value of CT increased from 84% and 15% to 100% and 100%, respectively, by adding a delayed phase [19]. The high NPV can be used to decrease the usefulness of TEE, so that it is selectively used only when CT is positive. Hong et al [20] found that patients who underwent cardiac MDCT followed by routine TEE had no significant difference in periprocedural stroke incidence when compared with selective TEE (0.2% incidence in each group, P > . 99); the sensitivity and NPV of CT were 100% and 100%, respectively, in this study. This strategy of selective use of TEE was also assessed during the COVID-19 pandemic, and the study showed no significant difference in periprocedural thromboembolic events between routine TEE versus selective use of TEE guided by CT (0% versus 0.4%, P = . 33, n = 637) [21]. Cardiac CT can assess LA size, which may help guide patient management as increased LA volume is an independent predictor of arrhythmia recurrence (n = 103; hazard ratio [HR], 1.011/mL; 95% confidence interval [CI], 1.003-1.020; P = . 002) [22]. CTA Coronary Arteries With IV Contrast CTA coronary arteries is used to assess coronary arterial disease. There is no relevant literature supporting the routine use of CTA coronary arteries with IV contrast to guide preprocedural planning before LA ablation. This can also be technically challenging due to irregular heart rhythm in these patients. Although not routinely recommended, if the specific clinical scenario requires coronary arterial evaluation in addition to preablation planning, the study may be performed as a CTA coronary examination and left atrium and pulmonary veins can be assessed simultaneously. MRA Chest Without and With IV Contrast MRA without and with IV contrast can assess LA size, pulmonary venous anatomy, and thrombus.