Section of Heart Rhythm Center, Okayama Heart Clinic, 54-1, Takeda, Naka-ku, Okayama 700-8251, Japan.
Europace. 2012 Jan;14(1):52-9. doi: 10.1093/europace/eur284. Epub 2011 Sep 8.
We evaluated the quality of non-enhanced multi-detector row computed tomography (MDCT) images of the pulmonary vein (PV) and the clinical results of catheter ablation to isolate the PV for treatment of atrial fibrillation (AF) without the use of contrast medium in patients with chronic kidney disease (CKD).
We compared PV images quantitatively and qualitatively between non-enhanced and enhanced images (n = 50). Procedural parameters and clinical outcomes were compared between catheter ablation for AF referring solely to non-enhanced MDCT in CKD patients (n = 20) and using enhanced MDCT images integrated with electroanatomic mapping in non-CKD patients (n = 30). In gross anatomy, complete agreement was obtained between non-enhanced and enhanced MDCT images. Bland-Altman plots and cumulative coefficient variation showed good agreement in PV diameter determination between non-enhanced and enhanced MDCT images. There were no statistically significant differences in procedural or fluoroscopic times between PV isolation only referring to non-enhanced MDCT images and that using enhanced MDCT images integrated with electroanatomic mapping. Similarly, the ablation success rate and AF-free status at 3 months after PV isolation did not differ between PV isolation referring only to non-enhanced MDCT images and that using an electroanatomic integration system. No complications occurred in PV isolation with or without enhanced MDCT.
Non-enhanced MDCT provides adequate PV image quality both quantitatively and qualitatively. The present study suggests that catheter ablation referring solely to non-enhanced MDCT images for AF could be performed with clinically acceptable results. These findings warrant further studies involving a much larger number of patients to confirm the present results.
我们评估了慢性肾脏病（CKD）患者在不使用对比剂的情况下，使用多排螺旋 CT（MDCT）进行非增强扫描时肺静脉（PV）的图像质量，并分析了单纯依靠非增强 MDCT 行导管消融术治疗心房颤动（AF）的临床结果。
我们对 50 例患者的非增强和增强图像进行了 PV 图像的定量和定性比较。我们比较了单纯依靠非增强 MDCT 行 AF 导管消融术的 CKD 患者（n = 20）和将非增强 MDCT 图像与电生理标测图整合后行导管消融术的非 CKD 患者（n = 30）的手术参数和临床结果。大体解剖学上，非增强 MDCT 与增强 MDCT 图像完全一致。Bland-Altman 图和累积系数变化表明，在 PV 直径的测定中，非增强 MDCT 与增强 MDCT 图像具有良好的一致性。仅参照非增强 MDCT 图像行 PV 隔离与将非增强 MDCT 图像与电生理标测图整合后行 PV 隔离在手术或透视时间上无统计学差异。同样，在参照非增强 MDCT 图像或电生理标测图整合系统行 PV 隔离后 3 个月的消融成功率和 AF 无复发率方面，两者之间也无差异。在有无增强 MDCT 的情况下行 PV 隔离均未发生并发症。
非增强 MDCT 可提供定量和定性上均足够的 PV 图像质量。本研究提示，单纯依靠非增强 MDCT 图像行 AF 导管消融术可以获得可接受的临床结果。这些发现需要进一步的研究，以纳入更多的患者来确认本研究的结果。
