(1) Background: Computer tomography (CT) is an imaging modality used in the pre-planning of radiofrequency catheter ablation (RFA) procedure in patients with cardiac arrhythmias. However, it is associated with a considerable ionizing radiation dose for patients. This study aims to develop and validate low-dose CT scanning protocols of the left atrium (LA) for RFA guidance. (2) Methods: 68 patients scheduled for RFA of atrial fibrillation were sequentially assigned to four groups of ECG-gated scanning protocols, based on the set tube current (TC): Group A (n = 20, TC = 33 mAs), Group B (n = 18, TC = 67 mAs), Group C (n = 10, TC = 135 mAs), and control Group D (n = 20, TC = 600 mAs). We used a 256-row multidetector CT with body weight-dependent tube voltage of 80 kVp (<70 kg), 100 kVp (70−90 kg), and 120 kVp (>90 kg). We evaluated scanning parameters including radiation dose, total scanning procedure time and signal-to-noise ratio (SNR). (3) Results: The average effective radiation dose (ED) was lower in Group A in comparison to Group B, C and D (0.83 (0.76−1.10), 1.55 (1.36−1.67), 2.91 (2.32−2.96) and 9.35 (8.00−10.04) mSv, p < 0.05). The total amount of contrast media was not significantly different between groups. The mean SNR was 6.5 (5.8−7.3), 7.1 (5.7−8.2), 10.8 (10.1−11.3), and 12.2 (9.9−15.7) for Group A, B, C and D, respectively. The comparisons of SNR in group A vs. B and C vs. D were without significant differences. (4) Conclusions: Optimized pre-ablation CT scanning protocols of the LA can reduce an average ED by 88.7%. Three dimensional (3D) models created with the lowest radiation protocol are useful for the integration of electro-anatomic-guided RFA procedures.

1st Department of Internal Medicine Cardioangiology St Anne's University Hospital Brno 656 91 Brno Czech Republic

Biostatistics International Clinical Research Center St Anne's University Hospital Brno 656 91 Brno Czech Republic

Department of Biology Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Cardiology and Structural Heart Diseases Medical University of Silesia 40 635 Katowice Poland

Department of Medical Imaging Faculty of Medicine St Anne's University Hospital Brno Masaryk University 656 91 Brno Czech Republic

IHU Liryc Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université 33600 Pessac France

INSERM UMR 1045 Cardiothoracic Research Center of Bordeaux University Bordeaux 33600 Pessac France

Institute of Mathematics and Statistics Masaryk University 611 37 Brno Czech Republic

Interventional Cardiac Electrophysiology Group International Clinical Research Center St Anne's University Hospital Brno 656 91 Brno Czech Republic

Nanotechnology CEITEC Masaryk University 625 00 Brno Czech Republic

Zobrazit více v PubMed

Kato R., Lickfett L., Meininger G., Dickfeld T., Wu R., Juang G., Angkeow P., LaCorte J., Bluemke D., Berger R., et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: Lessons learned by use of magnetic resonance imaging. Circulation. 2003;107:2004–2010. doi: 10.1161/01.CIR.0000061951.81767.4E. PubMed DOI

Chen J., Yang Z.-G., Xu H.-Y., Shi K., Long Q.-H., Guo Y.-K. Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT. Eur. Radiol. 2017;27:660–670. doi: 10.1007/s00330-016-4411-6. PubMed DOI

Skowerski M., Wozniak-Skowerska I., Hoffmann A., Nowak S., Skowerski T., Sosnowski M., Wnuk-Wojnar A.M., Mizia-Stec K. Pulmonary vein anatomy variants as a biomarker of atrial fi-brillation—CT angiography evaluation. BMC Cardiovasc. Disord. 2018;18:146. doi: 10.1186/s12872-018-0884-3. PubMed DOI PMC

Anand R., Gorev M., Poghosyan H., Pothier L., Matkins J., Kotler G., Moroz S., Armstrong J., Nemtsov S.V., Orlov M.V. Prospective randomized comparison of rotational angiography with three-dimensional reconstruction and computed tomography merged with electro-anatomical mapping: A two center atrial fibrillation ablation study. J. Interv. Card. Electrophysiol. 2016;46:71–79. doi: 10.1007/s10840-016-0111-z. PubMed DOI

Dong J., Calkins H., Solomon S.B., Lai S., Dalal D., Lardo A., Brem E., Preiss A., Berger R.D., Halperin H., et al. Integrated electroanatomic mapping with three-dimensional computed tomo-graphic images for real-time guided ablations. Circulation. 2006;113:186–194. doi: 10.1161/CIRCULATIONAHA.105.565200. PubMed DOI

Kistler P., Rajappan K., Harris S., Earley M.J., Richmond L., Sporton S.C., Schilling R.J. The impact of image integration on catheter ablation of atrial fibrillation using electroanatomic mapping: A prospective randomized study. Eur. Heart J. 2008;29:3029–3036. doi: 10.1093/eurheartj/ehn453. PubMed DOI

Richmond L., Rajappan K., Voth E., Rangavajhala V., Earley M.J., Thomas G., Harris S., Sporton S.C., Schilling R.J. Validation of Computed Tomography Image Integration into the EnSite NavX Mapping System to Perform Catheter Ablation of Atrial Fibrillation. J. Cardiovasc. Electrophysiol. 2008;19:821–827. doi: 10.1111/j.1540-8167.2008.01127.x. PubMed DOI

Park J.J. Computed Tomography for Assessment of Left Atrial Appendage Function. Korean Circ. J. 2019;49:181–182. doi: 10.4070/kcj.2018.0355. PubMed DOI PMC

Protection R. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP. 2007;37:1–332. PubMed

Wolf J., Stárek Z., Jež J., Lehar F., Lukasova M., Kulik T., Novak M. Rotational angiography of left ventricle to guide ventricular tachycardia ablation. Int. J. Cardiovasc. Imaging. 2015;31:899–904. doi: 10.1007/s10554-015-0636-8. PubMed DOI

Fahlenkamp U.L., Diaz Ramirez I., Wagner M., Schwenke C., Huppertz A., Hamm B., Lembcke A. Image quality of low-radiation dose left atrial CT using filtered back projection and an iterative reconstruction algorithm: Intra-individual comparison in unselected patients undergoing pul-monary vein isolation. Acta Radiol. 2018;59:161–169. doi: 10.1177/0284185117708472. PubMed DOI

Di Carlo A., Bellino L., Consoli D., Mori F., Zaninelli A., Baldereschi M., Cattarinussi A., D’Alfonso M.G., Gradia C., Sgherzi B., et al. Prevalence of atrial fibrillation in the Italian elderly population and projections from 2020 to 2060 for Italy and the European Union: The FAI Project. EP Eur. 2019;21:1468–1475. doi: 10.1093/europace/euz141. PubMed DOI

Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B., Castella M., Diener H.C., Heidbuchel H., Hendriks J., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in col-laboration with EACTS. Eur. Heart J. 2016;37:2893–2962. doi: 10.1093/eurheartj/ehw210. PubMed DOI

Hunter R.J., Ginks M., Ang R., Diab I., Goromonzi F.C., Page S., Baker V., Richmond L., Tayebjee M., Sporton S., et al. Impact of variant pulmonary vein anatomy and image integration on long-term out-come after catheter ablation for atrial fibrillation. Europace. 2010;12:1691–1697. doi: 10.1093/europace/euq322. PubMed DOI

Malchano Z.J., Neuzil P., Cury R.C., Holmvang G., Weichet J., Schmidt E.J., Ruskin J.N., Reddy V.Y. Integration of Cardiac CT/MR Imaging with Three-Dimensional Electroanatomical Mapping to Guide Catheter Manipulation in the Left Atrium: Implications for Catheter Ablation of Atrial Fibrillation. J. Cardiovasc. Electrophysiol. 2006;17:1221–1229. doi: 10.1111/j.1540-8167.2006.00616.x. PubMed DOI

Mah D.Y., Miyake C.Y., Sherwin E.D., Walsh A., Anderson M.J., Western K., Abrams D., Alexander M.E., Cecchin F., Walsh E.P., et al. The use of an integrated electroanatomic mapping system and intracardiac echocardiography to reduce radiation exposure in children and young adults undergoing ablation of supraventricular tachycardia. Europace. 2013;16:277–283. doi: 10.1093/europace/eut237. PubMed DOI PMC

Stárek Z., Lehar F., Jež J., Wolf J., Novak M. 3D X-ray imaging methods in support catheter ablations of cardiac arrhythmias. Int. J. Cardiovasc. Imaging. 2014;30:1207–1223. doi: 10.1007/s10554-014-0470-4. PubMed DOI

Tian J., Jeudy J., Smith M.F., Jimenez A., Yin X., Bruce P.A., Lei P., Turgeman A., Abbo A., Shekhar R., et al. Three-Dimensional Contrast-Enhanced Multidetector CT for Anatomic, Dynamic, and Perfusion Characterization of Abnormal Myocardium To Guide Ventricular Tachycardia Ablations. Circ. Arrhythmia Electrophysiol. 2010;3:496–504. doi: 10.1161/CIRCEP.109.889311. PubMed DOI

Picano E., Vano E. The Radiation Issue in Cardiology: The time for action is now. Cardiovasc. Ultrasound. 2011;9:35. doi: 10.1186/1476-7120-9-35. PubMed DOI PMC

Wagner M., Butler C., Rief M., Beling M., Durmus T., Huppertz A., Voigt A., Baumann G., Hamm B., Lembcke A., et al. Comparison of non-gated vs. electrocardiogram-gated 64-detector-row computed tomography for integrated electroanatomic mapping in patients undergoing pulmonary vein isolation. Europace. 2010;12:1090–1097. doi: 10.1093/europace/euq135. PubMed DOI

Hlaihel C., Boussel L., Cochet H., Roch J.A., Coulon P., Walker M.J., Douek P.C. Dose and image quality comparison between prospectively gated axial and retro-spectively gated helical coronary CT angiography. Br. J. Radiol. 2011;84:51–57. doi: 10.1259/bjr/13222537. PubMed DOI PMC

Thai W.-E., Wai B., Lin K., Cheng T., Heist E.K., Hoffmann U., Singh J.P., Truong Q.A. Pulmonary Venous Anatomy Imaging with Low-Dose, Prospectively ECG-Triggered, High-Pitch 128-Slice Dual-Source Computed Tomography. Circ. Arrhythmia Electrophysiol. 2012;5:521–530. doi: 10.1161/CIRCEP.111.968313. PubMed DOI PMC

Iwayama T., Arimoto T., Ishigaki D., Hashimoto N., Kumagai Y., Koyama Y., Kiribayashi N., Netsu S., Nishiyama S., Takahashi H., et al. The Clinical Value of Nongated Dual-Source Computed Tomography in Atrial Fibrillation Catheter Ablation. J. Cardiovasc. Electrophysiol. 2015;27:34–40. doi: 10.1111/jce.12826. PubMed DOI

Annoni A.D., Andreini D., Pontone G., Formenti A., Petullà M., Consiglio E., Nobili E., Baggiano A., Conte E., Mushtaq S., et al. Ultra-low-dose CT for left atrium and pulmonary veins imaging using new model-based iterative reconstruction algorithm. Eur. Heart J.—Cardiovasc. Imaging. 2015;16:1366–1373. doi: 10.1093/ehjci/jev103. PubMed DOI

Cereda A.F., de Luca F., Lanzone A.M., Cottini M., Pastori L., Sangiorgi G. Case report and systematic review of iatrogenic left atrial dissection in different cardiovascular specialties: A common treatment for an uncommon complication? Catheter. Cardiovasc. Interv. 2020;95:E30–E36. doi: 10.1002/ccd.28356. PubMed DOI

Thériault-Lauzier P., Spaziano M., Vaquerizo B., Buithieu J., Martucci G., Piazza N. Computed Tomography for Structural Heart Disease and Interventions. Interv. Cardiol. 2015;10:149–154. doi: 10.15420/ICR.2015.10.03.149. PubMed DOI PMC

Oudkerk M., Stillman A.E., Halliburton S.S., Kalender W.A., Möhlenkamp S., McCollough C.H., Vliegenthart R., Shaw L.J., Stanford W., Taylor A.J., et al. Coronary artery calcium screening: Current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Int. J. Cardiovasc. Imaging. 2008;24:645–671. doi: 10.1007/s10554-008-9319-z. PubMed DOI PMC

Hecht H.S. Coronary artery calcium scanning: Past, present, and future. JACC Cardiovasc. Imaging. 2015;8:579–596. doi: 10.1016/j.jcmg.2015.02.006. PubMed DOI