Background The outcome of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has improved thanks to left atrium (LA) anatomy reconstruction by cardiac computed tomography (CCT). A new model-based iterative reconstruction algorithm (MBIR) provides image noise reduction achieving effective radiation dose (ED) close to chest X-ray exposure. Aim of this study was comparing RFCA procedural characteristics, AF recurrence and radiation exposure between patients in whom RFCA was guided by CCT image integration with MBIR versus a CCT standard protocol. Methods Three-hundred consecutive patients with drug-refractory AF were studied with CCT using MBIR (Group 1; N:150) or CCT with standard protocol (Group 2; N:150) for LA evaluation and treated by image integration-supported RFCA. Image noise, signal to noise ratio (SNR), contrast to noise ratio (CNR), RFCA procedural characteristics, rate of AF recurrence and radiation exposure were compared. Results Group 1 showed higher SNR (25.9 ± 7.1 vs. 16.2 ± 4.8, p < 0.001) and CNR (23.3 ± 7.1 vs. 12.2 ± 4.2, p < 0.001) and lower image noise (22.3 ± 5.2 vs. 32.6 ± 8.1 HU, p < 0.001), fluoroscopy time (21 ± 12 vs. 29 ± 15 min, p < 0.01) and procedural duration (135 ± 89 vs. 172 ± 55, p < 0.001). Group 1 showed a 94% reduction of ED as compared to Group 2 (CCT-ED related: 0.41 ± 0.04 vs. 6.17 ± 4.11 mSv, p < 0.001; cumulative CCT + RFCA-ED related: 21.9 ± 17.9 vs. 36.0 ± 24.1 mSv, p < 0.001) with similar rate of AF recurrence (25% vs. 29%, p = 0.437). Conclusions CCT with MBIR allows accurate reconstruction of LA anatomy in AF patients undergoing RFCA with a sub-millisievert ED and comparable success rate of RFCA as compared to a standard CCT scan protocol.
- Atrial fibrillation
- Iterative reconstruction algorithm
- Radiation exposure
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine