Di Cori Andrea, Zucchelli Giulio, Faggioni Lorenzo, Segreti Luca, De Lucia Raffaele, Barletta Valentina, Viani Stefano, Paperini Luca, Parollo Matteo, Soldati Ezio, Caramella Davide, Bongiorni Maria Grazia
Second Division of Cardiology, New Santa Chiara Hospital Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.
Diagnostic and Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
J Interv Card Electrophysiol. 2021 Apr;60(3):477-484. doi: 10.1007/s10840-020-00764-4. Epub 2020 May 13.
Cardiac computed tomography (CT) is commonly used to study left atrial (LA) and pulmonary veins (PVs) anatomy before atrial fibrillation (AF) ablation. The aim of the study was to determine the impact of pre-procedural cardiac CT with 3D reconstruction on procedural outcomes and radiological exposure in patients who underwent radiofrequency catheter ablation (RFA) of AF.
In this registry, 493 consecutive patients (age 62 ± 8 years, 70% male) with paroxysmal (316) or persistent (177) AF who underwent first procedure of RFA were included. A pre-procedural CT scan was obtained in 324 patients (CT group). Antral pulmonary vein isolation was performed in all patients using an open-irrigation-tip catheter with a 3D electroanatomical navigation system. Procedural outcome, including radiological exposure, and clinical outcomes were compared among patients who underwent RFA with (CT group) and without (no CT group) pre-procedural cardiac CT.
Acute PV isolation was obtained in all patients, with a comparable overall complication rate between CT and no CT group (4.3% vs 3%, p = 0.7). No differences were observed about mean duration of the procedure (231 ± 60 vs 233 ± 58 min, p = 0.7) and fluoroscopy time (13 ± 10 vs 13 ± 8 min, p = 0.6) among groups. Cumulative radiation dose resulted significantly higher in the CT group compared with no CT group (8.9 ± 24 vs 4.8 ± 15 mSv, P = 0.02). At 1 year, freedom from AF/atrial tachycardia were comparable among groups (CT group, 227/324 (70%), vs no CT group,119/169 (70%), p = ns).
Pre-procedural CT does not improve safety and efficacy of AF ablation, increasing significantly the cumulative radiological exposure.
心脏计算机断层扫描（CT）常用于在房颤（AF）消融术前研究左心房（LA）和肺静脉（PVs）的解剖结构。本研究的目的是确定术前心脏CT三维重建对接受房颤射频导管消融（RFA）患者的手术结果和放射暴露的影响。
在本登记研究中，纳入了493例连续接受首次RFA手术的阵发性（316例）或持续性（177例）房颤患者（年龄62±8岁，70%为男性）。324例患者（CT组）进行了术前CT扫描。所有患者均使用带有三维电解剖导航系统的开放式灌注尖端导管进行肺静脉前庭隔离。比较了接受RFA术前有（CT组）和无（无CT组）心脏CT患者的手术结果（包括放射暴露）和临床结果。
所有患者均实现了急性肺静脉隔离，CT组和无CT组的总体并发症发生率相当（4.3%对3%，p = 0.7）。各组之间手术平均持续时间（231±60对233±58分钟，p = 0.7）和透视时间（13±10对13±8分钟，p = 0.6）无差异。与无CT组相比，CT组的累积辐射剂量显著更高（8.9±24对4.8±15 mSv，P = 0.02）。1年时，各组无房颤/房性心动过速的情况相当（CT组，227/324（70%），无CT组，119/169（70%），p = 无显著差异）。
术前CT不能提高房颤消融的安全性和有效性，反而会显著增加累积放射暴露。
