Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation
A head-to-head comparison
Monique R.M. Jongbloed, MD*,
Jeroen J. Bax, MD, PhD*,*,
Hildo J. Lamb, MD, PhD ,
Martijn S. Dirksen, MD, PhD,
K. Zeppenfeld, MD, PhD*,
Ernst E. van der Wall, MD, PhD*,
Albert de Roos, MD, PhD and
Martin J. Schalij, MD, PhD*
* Department of Cardiology
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Figure 1 Evaluation of pulmonary venous ostial insertion in three different orthogonal planes in a patient with separate insertion of both left and right pulmonary veins in the left atrium. The dotted line depicts the extrapolated outer left atrial border. (A) Sagittal plane. Both left pulmonary veins enter the left atrium separately. (B) Coronal plane and (C) transversal plane. (D) Three-dimensional reconstruction. No common truncal part is observed in any plane before the veins enter the left atrium. Left atrial insertion of these veins was therefore designated as separate. LA = left atrium; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.
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Figure 2 Common ostium of the left pulmonary veins, as evaluated in three different orthogonal planes and a three dimensional reconstruction using multislice computed tomography. (A) Sagittal plane. The superior and inferior pulmonary veins have united to form a common truncus before entering the left atrial body. (B) Coronal plane. (C) Transversal plane. (D) Three-dimensional reconstruction. A common truncus of the left pulmonary veins can be observed in all orthogonal planes and on the three-dimensional reconstruction. Abbreviations as in Figure 1.
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Figure 3 Method used to determine pulmonary vein ostial insertion in the left atrium using intracardiac echocardiography. The dotted line depicts the extrapolated outer left atrial border. Panels A and B represent separate insertion of left and right pulmonary veins, respectively, whereas panels C and D demonstrate a common ostium of the left and right pulmonary veins, respectively. Abbreviations as in Figure 1.
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Figure 4 Measurements of the left inferior pulmonary vein (LIPV) with multislice computed tomography in two directions (left and middle panels) using multiplanar reformatting, and with intracardiac echocardiography (right panel). (Left panel) Measurements in the anterior-posterior direction in the transversal orthogonal plane. The green line is placed parallel to the LIPV, and depicts the coronal plane, which is used to measure the ostium in the superior-inferior direction (middle panel). (Right panel) Measurement of the LIPV (upper panel) and of a common ostium of the left pulmonary veins (lower panel) using intracardiac echocardiography. AP = anterior-posterior; SI = superior-inferior; other abbreviations as in Figure 1.
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Figure 5 (Upper panels) Additional right pulmonary vein (arrow), as observed with multislice computed tomography (A) and with intracardiac echocardiography (B). (Lower panels) Common ostium (double arrow) of the left pulmonary veins, as observed with multislice computed tomography (C) and with intracardiac echocardiography (D). Abbreviations as in Figure 1.
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Figure 6 Bland-Altman analysis of measurements performed with multislice computed tomography (MSCT) and intracardiac echocardiography (ICE) in the anterior-posterior (AP) direction (left panel) and in the superior-inferior (SI) direction (right panel). The difference between all measurements performed with MSCT and with ICE was within two standard deviations from the average difference for the majority of measurements.
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