2nd Department of Cardiology, HCP Medical Centre, Poznan University of Medical Sciences, Poznan, Poland.
Kardiol Pol. 2012;70(9):924-30.
Efficacy and safety of radiofrequency (RF) ablation in patients with atrial fibrillation (AF) strongly depend on the possibility of three-dimensional (3D) visualisation of atria as well as the ostia of pulmonary veins. Current angiographic systems allow 3D visualisation of anatomical heart structures using rotational angiography.
To evaluate clinical usefulness of rotational angiography (3D-ATG) after contrast agent administration into the right atrium for the purpose of evaluating left atrial anatomy in patients undergoing RF ablation of AF.
We also compared images obtained using 3D-ATG with magnetic resonance imaging (MRI). In 18 consecutive patients undergoing RF ablation of AF or left-atrial tachycardia, 3D-ATG was performed uneventfully, followed by 3D reconstruction of the left atrium and the aorta. Ablation using the CARTO 3 system was successful in 17 patients. Total ablation time was 127 ± 28 min, fluoroscopy time 31 ± 8 min, and radiation dose was 413 ± 170 mGy. Mean fluoroscopy time for 3D-ATG was 1.75 ± 0.4 min and the mean radiation dose was 159 ± 57 mGy. Appropriate 3D visualisation of the left atrium was possible in 17 patients, including 16 patients in whom all 4 pulmonary venous ostia were imaged. In 1 patient, all right-sided pulmonary veins were located outside the scan area. In 1 case, 3D-ATG did not allow visualisation of the right inferior pulmonary vein, and in another case the left-sided veins had a common ostium as shown in MRI but not visualised in 3D-ATG.
Pulmonary vein diameter assessed by 3D-ATG was slightly higher than by MRI (16.6 ± 3.2 vs. 15.2 ± 3.6 mm, p = 0.28), although this was mainly related to a single nonvisualised right inferior pulmonary vein. Good agreement (< 2 mm) between the two methods for the assessment of pulmonary venous ostia was higher for the right-sided than the left-sided veins (62.5% vs. 44%, p = 0.03).
We conclude that 3D-ATG after contrast agent administration into the right atrium seems to be a safe and effective method to visualise pulmonary venous ostia and left atrial anatomy. It remains to be established whether it enables evaluation of anatomical anomalies.
射频（RF）消融术治疗心房颤动（AF）的疗效和安全性在很大程度上取决于能否对心房和肺静脉口进行三维（3D）可视化。目前的血管造影系统允许使用旋转血管造影术对心脏解剖结构进行 3D 可视化。
评估经右心房注入造影剂后行旋转血管造影术（3D-ATG）在评估行 RF 消融术的 AF 患者左心房解剖结构中的临床应用价值。
我们还将 3D-ATG 与磁共振成像（MRI）进行了比较。在 18 例连续行 RF 消融术治疗 AF 或左房性心动过速的患者中，3D-ATG 均顺利完成，随后对左心房和主动脉进行 3D 重建。使用 CARTO 3 系统消融成功 17 例。总消融时间为 127±28 分钟，透视时间为 31±8 分钟，辐射剂量为 413±170mGy。3D-ATG 的平均透视时间为 1.75±0.4 分钟，平均辐射剂量为 159±57mGy。17 例患者均能获得合适的左心房 3D 可视化，其中 16 例患者能显示所有 4 个肺静脉口。1 例患者所有右肺静脉均位于扫描区外。1 例患者右肺下静脉无法行 3D-ATG 显示，另 1 例患者左肺静脉共干在 MRI 中可见，但在 3D-ATG 中未见显示。
3D-ATG 评估的肺静脉直径稍大于 MRI（16.6±3.2 比 15.2±3.6mm，p=0.28），尽管这主要与单个未显示的右肺下静脉有关。两种方法评估肺静脉口时，右肺静脉的一致性（<2mm）高于左肺静脉（62.5%比 44%，p=0.03）。
我们的结论是，经右心房注入造影剂后行 3D-ATG 似乎是一种安全有效的方法，可用于显示肺静脉口和左心房解剖结构。它是否能够评估解剖异常还有待确定。
