Цель исследования

medvis

Медицинская визуализация

Medical Visualization

1607-07632408-9516

RDS-Media Ltd.

10.24835/1607-0763-2017-5-39-55

medvis-472

Research Article

ГРУДНАЯ КЛЕТКА

THORAX

Оценка анатомии и функции левого предсердия по данным мультиспиральной компьютерной томографии при подготовке к радиочастотной катетерной абляции у пациентов с фибрилляцией предсердий

Evaluation of Left Atrial Anatomy and Function using Multidetector Computed Tomography in Patients Undergoing Catheter Ablation for Atrial Fibrillation

Гурина

В. И.

Gurina

V. I.

аспирант отдела лучевой диагностики ФГБУ “Институт хирургии им. А.В. Вишневского” МЗ РФ, Москва

119997 Москва, ул. Большая Серпуховская, 27. Институт хирургии им. А.В. Вишневского. Тел.: 8-903-292-66-94

resident of Radiology Department of A.V. Vishnevsky Institute of Surgery, Moscow

119997 Moscow, Bolshaya Serpukhovskaya str., 27. A.V. Vishnevsky Institute of Surgery. Phone: +7-903-292-66-94

vera.gurina_msk@mail.ru

Кондратьев

Е. В.

Kondrat’ev

E. V.

канд. мед. наук, старший научный сотрудник отделения рентгенологии и магнитно-резонансных исследований ФГБУ “Институт хирургии им. А.В. Вишневского” МЗ РФ, Москва

cand. of med. sci., senior research of radiology department of A.V. Vishnevsky Institute of Surgery, Moscow

Ревишвили

А. Ш.

Revishvily

A. Sh.

академик РАН, профессор, доктор мед. наук, директор ФГБУ “Институт хирургии им. А.В. Вишневского” МЗ РФ, Москва

Member of RAS, doct. of med. sci, professor, head of A.V. Vishnevsky Institute of Surgery, Moscow

Алимурзаева

М. З.

Alimurzaeva

M. Z.

аспирант отдела лучевой диагностики ФГБУ “Институт хирургии им. А.В. Вишневского” МЗ РФ, Москва

resident of Radiology Department of A.V. Vishnevsky Instituteof Surgery, Moscow

ФГБУ “Институт хирургии им. А.В. Вишневского” Минздрава РоссииРоссияA.V. Vishnevsky Institute of SurgeryRussian Federation

2017

28102017

053955

2017

Гурина В.И., Кондратьев Е.В., Ревишвили А.Ш., Алимурзаева М.З.

Gurina V.I., Kondrat’ev E.V., Revishvily A.S., Alimurzaeva M.Z.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://medvis.vidar.ru/jour/article/view/472

Фибрилляция предсердий (ФП) является наиболее распространенным нарушением ритма в клинической практике. Оптимальной терапией ФП, рефрактерной к противоаритмическим препаратам, на настоящий момент признана катетерная абляция (КА) аритмогенных очагов. Визуализация перед проведением процедуры необходима для детальной оценки левого предсердия, легочных вен и прилежащих анатомических структур, что позволяет оптимально спланировать вмешательство, а также спрогнозировать и предотвратить возможные осложнения.

Цель исследования

Цель исследования: определить роль мультиспиральной компьютерной томографии (МСКТ) с контрастным усилением в обследовании пациентов с ФП, а также оценить перспективы развития данной мето дики на основании систематического обзора мировой литературы.

Материал и методы

Материал и методы. Проанализированы 140 статей, находящихся в свободном доступе в системе PubMed за период с 01.2009 по 01.2017 по запросам “MDCT left atrium”, “MDCT pulmonary veins”, “MDCT atrial appendage”, а также ряд русскоязычных публикаций в системе eLibrary.

Результаты

Результаты. В обзоре литературы представлены и систематизированы имеющиеся данные по эпидемиологии и механизмам развития ФП, приведена актуальная классификация. Рассмотрены преимущества МСКТ-диагностики перед другими методами визуализации как в рамках подготовки к процедуре КА, так и последующего ведения пациентов.

Заключение

Заключение. МСКТ является точным, эффективным и доступным методом, отвечающим требованиям визуализации в рамках подготовки к КА. Кроме того, МСКТ в совокупности с навигационной системой электроанатомического картирования увеличивает безопасность и эффективность процедуры. В послеоперационном периоде МСКТ может быть использована для диагностики осложнений и оценки результата.

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Сatheter ablation (CA) of arrhythmogenic foci is supposed to be an established treatment option for symptomatic patients with AF, refractory to antiarrhythmic therapy. Pre-procedural imaging is indispensable for the assessment of left atrium, pulmonary veins and adjacent anatomy, and facilitates selection of the ablation strategy to achieve an optimal result and minimize the risk of complications.

Purpose

Purpose: to evaluate the role of contrast-enhanced MDCT in patients with AF; also to present the prospects for further development of this method according to the systemic review of world research data.

Materials and methods

Materials and methods. 140 free access articles requested as “MDCT left atrium”, “MDCT pulmonary veins”, “MDCT atrial appendage” from 01.2009 until 01.2017 were analyzed in PubMed, as well as a number of Russianlanguage articles in eLibrary.

Results

Results. This literature review reports and systematizes available data on epidemiology and mechanisms of AF, represents current classification. In addition were analyzed advantages of MDCT over other methods of visualization while planning the CA and follow-up.

Conclusion

Conclusion. MDCT is precise, effective and accessible option, which satisfies visualization requirements during the preparation for CA. Moreover, using MDCT in combination with electro-mapping systems increases safety and effectiveness of the procedure. In postoperative period MDCT can be used for complications diagnostic and results assessment.

фибрилляция предсердийкатетерная абляцияМСКТобъем левого предсердиялегочные веныушко левого предсердияосложнения катетерной абляции

atrial fibrillationcatheter ablationMDCTleft atrial volumepulmonary veinsleft atrial appendagecomplications of catheter ablation

References1

Сулимов В.А., Голицын С.П., Панченко Е.П., Попов С.В., Ревишвили А.Ш., Шубик Ю.В., Явелов И.С. Диагностика и лечение фибрилляции предсердий. Рекомендации РКО, ВНОА и АССХ. Российский кардиологический журнал. 2013; 4 S3 (102); 1–100. Sulimov V.A., Golitsyn S.P., Panchenko E.P, Popov S.V., Revishvili A.Sh., Shubik Yu.V., Yavelov I.S. Diagnosis and treatment of atrial fibrillation. Recommendations of the RKO, VNOA and the ACVS. Russian Journal of Cardiology. 2013; (4s3): 5–100. (In Russian)

Calkins H., Kuck K.H., Cappato R., Brugada J., Camm A.J., Chen S.A., Crijns H.J., Damiano R.J. Jr, Davies D.W., DiMarco J., Edgerton J., Ellenbogen K., Ezekowitz M.D., Haines D.E., Haissaguerre M., Hindricks G., Iesaka Y., Jackman W., Jalife J., Jais P., Kalman J., Keane D., Kim Y.H., Kirchhof P., Klein G., Kottkamp H., Kumagai K., Lindsay B.D., Mansour M., Marchlinski F.E., McCarthy P.M., Mont J.L., Morady F., Nademanee K., Nakagawa H., Natale A., Nattel S., Packer D.L., Pappone C., Prystowsky E., Raviele A., Reddy V., Ruskin J.N., Shemin R.J., Tsao H.M., Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J. Interv. Card. Electrophysiol. 2012; 33 (2): 171–257. DOI: 10.1007/s10840-012-9672-7.

Shroff G.S., Guirguis M.S., Ferguson E.C., Oldham S.A., Kantharia B.K. CT imaging of complications of catheter ablation for atrial fibrillation. Clin. Radiol. 2014; 69 (1): 96–102. DOI: 10.1016/j.crad.2013.08.018.

Haïssaguerre M., Jaïs P., Shah D.C., Takahashi A., Hocini M., Quiniou G., Garrigue S., Le Mouroux A., Le Métayer P., Clémenty J. Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins. N. Engl. J. Med. 1998; 339 (10): 659–666.

Chen Y.J., Chen S.A. Electrophysiology of pulmonary veins. J. Cardiovasc. Electrophysiol. 2006; 17: 220–224.

Lacomis J.M., Wigginton W., Fuhrman C., Schwartzman D., Armfield D.R., Pealer K.M. Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation. Radiographics. 2003; 23 Spec No: S35–48; discussion S48-50.

Ревишвили А.Ш., Любкина Е.В., Лабарткава Е.З. Радиочастотная изоляция левого предсердия или аблация устьев легочных вен при фибрилляции предсердий: достоинства и недостатки различных подходов. Анналы аритмологии. 2005; 2: 68–75. Revishvili A.Sh., Lyubkina E.V., Labartkava E.Z. Radiofrequency isolation of the left atrium or ablation of the mouths of the pulmonary veins in atrial fibrillation: advantages and disadvantages of different approaches. Annals of arrhythmology. 2005; 2: 68–75. (In Russian)

Ревишвили А.Ш., Рзаев Ф.Г., Ханкишиева Ф.Р., Джорджикия Т. Р. Результаты интервенционного лечения персистентной и перманентной форм фибрилляции предсердий. Анналы аритмологии. 2006; 6: 64–73. Revishvili A.Sh., Rzaev F.G., Khankishieva F.R., Georgikiya T.R. Interventional treatment of persistent and permanent forms of atrial fibrillation. Annals of arrhythmology. 2006; 6: 64–73. (In Russian)

Ардашев А.В., Желяков Е.Г., Долгушина Е.А., Рыбаченко М.С., Мангутов Д.А., Конев А.В., Волошко С.В., Врублевский О.Ю., Крючко М.В., Ливенцева Э.Н. Радиочастотная катетерная абляция хронической формы фибрилляции предсердий методом изоляции легочных вен и анатомической модификации субстрата аритмии. Кардиология. 2009; 1: 39–46. Ardashev A.V., Zhelyakov E.G., Dolgushina E.A., Rybachenko M.S., Mangutov D.A., Konev A.V., Voloshko S.V., Vrublevsky O.Yu., Kryuchko M.V., Liventseva E.N. Radiofrequency catheter ablation of the chronic form of atrial fibrillation by the method of isolation of pulmonary veins and anatomical modification of the arrhythmia substrate. Cardiology. 2009; 1: 39–46. (In Russian)

Walters T.E., Ellims A.H., Kalman J.M. The Role of Left Atrial Imaging in the Management of Atrial Fibrillation. Progress Cardiovasc. Dis. 2015; 58 (2): 136–151. DOI: 10.1016/j.pcad.2015.07.010.

Kuchynka P., Podzimkova J., Masek M., Lambert L., Cerny V., Danek B., Palecek T. The Role of Magnetic Resonance Imaging and Cardiac Computed Tomography in the Assessment of Left Atrial Anatomy, Size, and Function. Biomed Res. Int. 2015; 2015:247865. DOI: 10.1155/2015/247865.

Spencer K.T., Mor-Avi V., Gorcsan J. 3rd, DeMaria A.N., Kimball T.R., Monaghan M.J., Perez J.E., Weinert L., Bednarz J., Edelman K., Kwan O.L., Glascock B., Hancock J., Baumann C., Lang R.M. Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart. 2001; 85 (3): 272–277.

Abhayaratna W.P., Seward J.B., Appleton C.P., Douglas P.S., O.h J.K., Tajik A.J., Tsang T.S. Left atrial size: physiologic determinants and clinical applications. J. Am. Coll. Cardiol. 2006; 47: 2357–2363.

Casaclang-Verzosa G., Gersh B.J., Tsang T.S. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J. Am. Coll. Cardiol. 2008; 51: 1–11.

Aldhoon B., Melenovsky V., Peichl P., Kautzner J. New insights into mechanisms of atrial fibrillation. Physiol. Res. 2009; 59: 1–12.

Mathew S.T., Patel J., Joseph S. Atrial fibrillation: mechanistic insights and treatment options. Eur. J. Intern. Med. 2009; 20: 672–681.

Haïssaguerre M., Hocini M., Sanders P., Sacher F., Rotter M., Takahashi Y., Rostock T., Hsu L.F., Bordachar P., Reuter S., Roudaut R., Clémenty J., Jaïs P. Catheter ablation of long- lasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J. Cardiovasc. Electrophysiol. 2005; 16 (11): 1138–1147. DOI: 10.1111/j.1540-8167.2005.00308.x.

Vasamreddy C.R., Lickfett L., Jayam V.K., Nasir K., Bradley D.J., Eldadah Z., Dickfeld T., Berger R., Calkins H. Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter. J. Cardiovasc. Electrophysiol. 2004; 15 (6): 692–697. DOI: 10.1046/j.1540-8167.2004.03538.x.

Sohns C., Sohns J.M., Vollmann D., Lüthje L., Bergau L., Dorenkamp M., Zwaka P.A., Hasenfuß G., Lotz J., Zabel M. Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation. Eur. Heart J. Cardiovasc. Imaging. 2013; 14 (7): 684–691. DOI: 10.1093/ehjci/jet017.

Berruezo A., Tamborero D., Mont L., Benito B., Tolosana J.M., Sitges M., Vidal B., Arriagada G., Méndez F., Matiello M., Molina I., Brugada J. Preprocedural predictors of atrial fibrillation recurrence after circum ferential pulmonary vein ablation. Eur. Heart J. 2007; 28 (7): 836–841. DOI: 10.1093/eurheartj/ehm027.

Jongnarangsin K., Chugh A., Good E., Mukerji S., Dey S., Crawford T., Sarrazin J.F., Kuhne M., Chalfoun N., Wells D., Boonyapisit W., Pelosi F.Jr., Bogun F., Morady F., Oral H. Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J. Cardiovasc. Electrophysiol. 2008; 19 (7): 668–672. DOI: 10.1111/j.1540-8167.2008.01118.x.

Wissner E., Kuck K.H. Improving prediction of long-term success of ablation for atrial fibrillation. Heart. 2011; 97 (22): 1817–1818. DOI: 10.1136/hrt.2011.224279.

Hof I., Chilukuri K., Arbab-Zadeh A., Scherr D., Dalal D., Nazarian S., Henrikson C., Spragg D., Berger R., Marine J., Calkins H. Does left atrial volume and pulmonary venous anatomy predict the outcome of catheter ablation of atrial fibrillation? J. Cardiovasc. Electrophysiol. 2009; 20 (9): 1005–1010. DOI:10.1111/j.1540-8167.2009.01504.x.

Abecasis J., Dourado R., Ferreira A., Saraiva C., Cavaco D., Santos K.R., Morgado F.B., Adragão P., Silva A. Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace. 2009; 11 (10): 1289–1294. DOI:10.1093/europace/eup198.

von Bary C., Dornia C., Eissnert C., Nedios S., Roser M., Hamer O.W., Gerds-Li J.H., Paetsch I., Jahnke C., Gebker R., Weber S., Fleck E., Kriatselis C. Predictive value of left atrial volume measured by non-invasive cardiac imaging in the treatment of paroxysmal atrial fibrillation. J. Interv. Card. Electrophysiol. 2012; 34 (2): 181–188. DOI: 10.1007/s10840-011-9641-6.

Tsao H.M., Hu W.C., Wu M.H., Tai C.T., Chang S.L., Lin Y.J., Lo L.W., Huang C.C., Hu Y.F., Sheu M.H., Chang C.Y., Chen S.A. The impact of catheter ablation on the dynamic function of the left atrium in patients with atrial fibrillation: insights from four-dimensional computed tomographic images. J. Cardiovasc. Electrophysiol. 2010; 21 (3): 270–277. DOI: 10.1111/j.1540-8167.2009.01618.x.

Stojanovska J., Cronin P., Gross B.H., Kazerooni E.A., Tsodikov A., Frank L., Oral H. Left atrial function and maximum volume as determined by MDCT are independently associated with atrial fibrillation. Acad. Radiol. 2014; 21 (9): 1162–1171. DOI:10.1016/j.acra.2014.02.018.

Park M.J., Jung J.I., Oh Y.S., Youn H.J. Assessment of the structural remodeling of the left atrium by 64-multislice cardiac CT: comparative studies in controls and patients with atrial fibrillation. Int. J. Cardiol. 2012; 159 (3): 181–186. DOI:10.1016/j.ijcard.2011.02.053.

Nakamura K., Funabashi N., Uehara M., Ueda M., Murayama T., Takaoka H., Komuro I. Left atrial wall thickness in paroxysmal atrial fibrillation by multislice-CT is initial marker of structural remodeling and predictor of transition from paroxysmal to chronic form. Int. J. Cardiol. 2011; 148 (2): 139–147. DOI:10.1016/j.ijcard.2009.10.032.

Makita Y., Nakano Y., Oda N., Suenari K., Sairaku A., Kajihara K., Tokuyama T., Motoda C., Fujiwara M., Yamamoto H., Awai K., Kihara Y. Use of preprocedural multidetector computed tomography to decrease atrial fibrillation recurrence following extensive encircling circumferential pulmonary vein isolation. J. Cardiol. 2012; 60 (3): 236–2341. DOI: 10.1016/j.jjcc.2012.03.007.

Fuchs A., Kühl J.T., Lønborg J., Engstrøm T., Vejlstrup N., Køber L., Kofoed K.F. Automated assessment of heart chamber volumes and function in patients with previous myocardial infarction using multidetector computed tomography. J. Cardiovasc. Comput. Tomogr. 2012; 6 (5): 325–334. DOI:10.1016/j.jcct.2012.01.006.

Wolf F., Ourednicek P., Loewe C., Richter B., Gössinger H.D., Gwechenberger M., Plank C., Schernthaner R.E., Toepker M., Lammer J., Feuchtner G.M. Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency-catheter ablation: comparison of a manual and automated 3D volume segmentation method. Eur. J. Radiol. 2010; 75 (2): e141–е146. DOI:10.1016/j.ejrad.2010.03.020.

Hof I., Arbab-Zadeh A., Dong J., Scherr D., Chilukuri K., Calkins H. Validation of a simplified method to determine left atrial volume by computed tomography in patients with atrial fibrillation. Am. J. Cardiol. 2008; 102 (11): 1567–1570. DOI:10.1016/j.amjcard.2008.07.048.

Mahabadi A.A., Samy B., Seneviratne S.K., Toepker M.H., Bamberg F., Hoffmann U., Truong Q.A. Quantitative assessment of left atrial volume by electrocardiographicgated contrast-enhanced multidetector computed tomography. J. Cardiovasc. Comput. Tomogr. 2009; 3 (2): 80–87. DOI: 10.1016/j.jcct.2009.02.002.

Gweon H.M., Kim S.J., Kim T.H., Lee S.M., Hong Y.J., Rim S.J. Evaluation of left atrial volumes using multidetector computed tomography: comparison with echocardiography. Korean J. Radiol. 2010; 11 (3): 286–294. DOI:10.3348/kjr.2010.11.3.286.

Hof I., Arbab-Zadeh A., Scherr D., Chilukuri K., Dalal D., Abraham T., Lima J., Calkins H. Correlation of left atrial diameter by echocardiography and left atrial volume by computed tomography. J. Cardiovasc. Electrophysiol. 2009; 20 (2): 159–163. DOI: 10.1111/j.1540-8167.2008.01310.x.

Koka A.R., Yau J., Van Why C., Cohen I.S., Halpern E.J. Underestimation of left atrial size measured with transthoracic echocardiography compared with 3D MDCT. Am. J. Roentgenol. 2010; 194 (5): W375–W3781. DOI: 10.2214/AJR.09.3183.

Avelar E., Durst R., Rosito G.A., Thangaroopan M., Kumar S., Tournoux F., Chan R.C., Hung J., Hoffmann U., Abbara S., Brady T., Cury R.C. Comparison of the accuracy of multidetector computed tomography versus twodimensional echocardiography to measure left atrial volume. Am. J. Cardiol. 2010; 106 (1): 104–109. DOI:10.1016/j.amjcard.2010.02.021.

Christiaens L., Lequeux B., Ardilouze P., Ragot S., Mergy J., Herpin D., Bonnet B., Allal J. A new method for measurement of left atrial volumes using 64-slice spiral computed tomography: comparison with two-dimensional echocardiographic techniques. Int. J. Cardiol. 2009; 131 (2): 217–224. DOI:10.1016/j.ijcard.2007.10.020.

Agner B.F., Kühl J.T., Linde J.J., Kofoed K.F., Åkeson P., Rasmussen B.V., Jensen G.B., Dixen U. Assessment of left atrial volume and function in patients with permanent atrial fibrillation: comparison of cardiac magnetic resonance imaging, 320-slice multi-detector computed tomography, and transthoracic echocardiography. Eur. Heart J. Cardiovasc. Imaging. 2014; 15 (5): 532–540. DOI: 10.1093/ehjci/jet239.

Miyasaka Y., Tsujimoto S., Maeba H., Yuasa F., Takehana K., Dote K., Iwasaka T. Left atrial volume by real-time threedimensional echocardiography: validation by 64-slice multidetector computed tomography. J. Am. Soc. Echocardiogr. 2011; 24 (6): 680–686. DOI: 10.1016/j.echo.2011.03.009.

Kanaji Y., Miyazaki S., Iwasawa J., Ichihara N., Takagi T., Kuroi A., Nakamura H., Taniguchi H., Hachiya H., Iesaka Y. Pre-procedural evaluation of the left atrial anatomy in patients referred for catheter ablation of atrial fibrillation. J. Cardiol. 2016; 67 (1): 115–1121. DOI: 10.1016/j.jjcc.2015.02.016.

Marom E.M., Herndon J.E., Kim Y.H., McAdams H.P. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 2004; 230 (3): 824–829. Epub 2004 Jan 22. DOI: 10.1148/radiol.2303030315.

McLellan A.J., Ling L.H., Ruggiero D., Wong M.C., Walters T.E., Nisbet A., Shetty A.K., Azzopardi S., Taylor A.J., Morton J.B., Kalman J.M., Kistler P.M. Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation. Heart Rhythm. 2014; 11 (4): 549–556. DOI: 10.1016/j.hrthm.2013.12.025.

Patel S.N., French A., Mathias H., Lyen S., Hamilton M.C., Manghat N.E. Presence of left atrial diverticula, accessory appendages, and normal variant pulmonary venous anatomy diagnosed using MDCT and adverse outcomes following radiofrequency catheter ablation therapy in patients with drug-refractory atrial fibrillation: an exploratory study. Clin. Radiol. 2013; 68 (8): 762–769. DOI:10.1016/j.crad.2013.02.005.

Sohns C., Sohns J.M., Bergau L., Sossalla S., Vollmann D., Lüthje L., Staab W., Dorenkamp M., Harrison J.L., O'Neill M.D., Lotz J., Zabel M. Pulmonary vein anatomy predicts freedom from atrial fibrillation using remote magnetic navigation for circumferential pulmonary vein ablation. Europace. 2013; 15 (8): 1136–1142. DOI:10.1093/europace/eut059.

Cronin P., Kelly A.M., Desjardins B., Patel S., Gross B.H., Kazerooni E.A., Morady F., Oral H., Carlos R.C. Normative analysis of pulmonary vein drainage patterns on multidetector CT with measurements of pulmonary vein ostial diameter and distance to first bifurcation. Acad. Radiol. 2007; 14 (2): 178–188 DOI: 10.1016/j.acra.2006.11.004.

Manghat N.E., Mathias H.C., Kakani N., Hamilton M.C., Morgan-Hughes G., Roobottom C.A. Pulmonary venous evaluation using electrocardiogram-gated 64-detector row cardiac CT. Br. J. Radiol. 2012; 85 (1015): 965–971. DOI: 10.1259/bjr/79302681.

Thorning C., Hamady M., Liaw J.V., Juli C., Lim P.B., Dhawan R., Peters N.S., Davies D.W., Kanagaratnam P., O'Neill M.D., Wright A.R. CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation. Clin. Imaging. 2011; 35 (1): 1–9. DOI: 10.1016/j.clinimag.2009.11.005.

Akiba T., Marushima H., Odaka M., Harada J., Kobayashi S., Morikawa T. Pulmonary vein analysis using threedimensional computed tomography angiography for thoracic surgery. Gen. Thorac. Cardiovasc. Surg. 2010; 58 (7): 331–335. DOI:10.1007/s11748-010-0592-0.

den Uijl D.W., Tops L.F., Delgado V., Schuijf J.D., Kroft L.J., de Roos A., Boersma E., Trines S.A., Zeppenfeld K., Schalij M.J., Bax J.J. Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. Am. J. Cardiol. 2011; 107 (2): 243–249. DOI:10.1016/j.amjcard.2010.08.069.

Wagner M., Butler C., Rief M., Beling M., Durmus T., Huppertz A., Voigt A., Baumann G., Hamm B., Lembcke A., Vogtmann T. 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 (8): 1090–1097. DOI: 10.1093/europace/euq135.

Tsao H.M., Hu W.C., Wu M.H., Tai C.T., Chang S.L., Lin Y.J., Lo L.W., Hu Y.F., Wu T.J., Sheu M.H., Chang C.Y., Chen S.A. Characterization of the dynamic function of the pulmonary veins before and after atrial fibrillation ablation using multi-detector computed tomographic images. Int. J. Cardiovasc. Imaging. 2011; 27 (7): 1049–1058. DOI: 10.1007/s10554-010-9752-7.

Kistler P.M., Rajappan K., Jahngir M. Earley M.J., Harris S., Abrams D., Gupta D., Liew R., Ellis S., Sporton S.C., Schilling R.J. The impact of CT image integration into an electroanatomic mapping system on clinical outcomes of catheter ablation of atrial fibrillation. J. Cardiovasc. Electrophysiol. 2006; 17 (10): 1093–1101.

Martinek M., Nesser H.J., Aichinger J., Boehm G., Purerfellner H. Impact of integration of multislice computed tomography imaging into three-dimensional electroanatomic mapping on clinical outcomes, safety, and efficacy using radiofrequency ablation for atrial fibrillation. Pacing Clin. Electrophysiol. 2007; 30 (10): 1215–1223. DOI: 10.1111/j.1540-8159.2007.00843.x.

Han S.W., Nam H.S., Kim S.H., Lee J.Y., Lee K.Y., Heo J.H. Frequency and significance of cardiac sources of embolism in the TOAST classification. Cerebrovasc. Dis. 2007; 24 (5): 463– 468. Epub 2007 Sep 19.

Zabalgoitia M., Halperin J.L., Pearce L.A., Blackshear J.L., Asinger R.W., Hart R.G. Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. Stroke Prevention in Atrial Fibrillation III Investigators. J. Am. Coll. Cardiol. 1998; 31 (7): 1622–1626.

Fuster V., Rydén L.E., Cannom D.S., Crijns H.J., Curtis A.B., Ellenbogen K.A., Halperin J.L., Le Heuzey J.Y., Kay G.N., Lowe J.E., Olsson S.B., Prystowsky E.N., Tamargo J.L., Wann S., Smith S.C .Jr, Jacobs A.K., Adams C.D., Anderson J.L., Antman E.M., Halperin J.L., Hunt S.A., Nishimura R., Ornato J.P., Page R.L., Riegel B., Priori S.G., Blanc J.J., Budaj A., Camm A.J., Dean V., Deckers J.W., Despres C., Dickstein K., Lekakis J., McGregor K., Metra M., Morais J., Osterspey A., Tamargo J.L., Zamorano J.L.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114 (7): e257–354. Erratum in: Circulation. 2007; 116 (6): e138.

Hilberath J.N., Oakes D.A., Shernan S.K., Bulwer B.E., D'Ambra M.N., Eltzschig H.K. Safety of transesophageal echocardiography. J. Am. Soc. Echocardiogr. 2010; 23 (11): 1115–1127; quiz 1220-1. DOI: 10.1016/j.echo.2010.08.013.

Martinez M.W., Kirsch J., Williamson E.E., Syed I.S., Feng D., Ommen S., Packer D.L., Brady P.A. Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation. JACC Cardiovasc. Imaging. 2009; 2 (1): 69–76. DOI: 10.1016/j.jcmg.2008.09.011.

Maltagliati A., Pontone G., Annoni A., Formenti A., Galli C.A., Tamborini G., Alimento M., Andreini D., Tondo C., Pepi M. Multidetector computed tomography vs multiplane transesophageal echocardiography in detecting atrial thrombi in patients candidate to radiofrequency ablation of atrial fibrillation. Int. J. Cardiol. 2011; 152 (2): 251–254. DOI: 10.1016/j.ijcard.2011.07.086.

Singh N.K., Nallamothu N., Zuck V.P., Issa Z.F. Left atrial appendage filling defects on 64- slice multidetector computed tomography in patients undergoing pulmonary vein isolation: predictors and comparison to transesophageal echocardiography. J. Comput. Assist. Tomogr. 2009; 33 (6): 946–951. DOI:10.1097/RCT.0b013e31819cabc3.

Hur J., Kim Y.J., Lee H.J., Ha J.W., Heo J.H., Choi E.Y., Shim C.Y., Kim T.H., Nam J.E., Choe K.O, Choi B.W. Left atrial appendage thrombi in stroke patients: detection with two-phase cardiac CT angiography versus transesophageal echocardiography. Radiology. 2009; 251 (3): 683–690. DOI: 10.1148/radiol.2513090794.

Kim S.C., Chun E.J., Choi S.I., Lee S.J., Chang H.J., Han M.K., Bae H.J., Park J.H. Differentiation between spontaneous echocardiographic contrast and left atrial appendage thrombus in patients with suspected embolic stroke using two-phase multidetector computed tomography. Am. J. Cardiol. 2010; 106 (8): 1174–1181. DOI: 10.1016/j.amjcard.2010.06.033.

Hur J., Kim Y.J., Lee H.J., Nam J.E., Ha J.W., Heo J.H., Chang H.J., Kim H.S., Hong Y.J., Kim H.Y., Choe K.O., Choi B.W. Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke: a prospective comparison study with transesophageal echocardiography. Stroke. 2011; 42 (9): 2471–2477. DOI: 10.1161/STROKEAHA.110.611293.

Hur J., Kim Y.J., Lee H.J., Nam J.E., Hong Y.J., Kim H.Y., Lee J.W., Choi B.W. Cardioembolic stroke: dual-energy cardiac CT for differentiation of left atrial appendage thrombus and circulatory stasis. Radiology. 2012; 263 (3): 688–695. DOI: 10.1148/radiol.12111691.

Kapa S., Martinez M.W., Williamson E.E., Ommen S.R., Syed I.S., Feng D., Packer D.L., Brady P.A. ECG-gated dual-source CT for detection of left atrial appendage thrombus in patients undergoing catheter ablation for atrial fibrillation. J. Interv. Card. Electrophysiol. 2010; 29 (2): 75–81. DOI: 10.1007/s10840-010-9505-5.

Sawit S.T., Garcia-Alvarez A., Suri B., Gaztanaga J., Fernandez-Friera L., Mirelis J.G., D'Anca M., Fuster V., Sanz J., Garcia M.J. Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation. Am. J. Cardiol. 2012; 109 (5): 677–684. DOI: 10.1016/j.amjcard.2011.10.028.

Staab W., Sohns C., Zwaka P.A., Sohns J.M., Schwarz A., Schneider S., Vollmann D., Zabel M., Hasenfuß G., Lotz J. Split-bolus single-phase cardiac multidetector computed tomography for reliable detection of left atrial thrombus: comparison to transesophageal echocardiography. Rofo. 2014; 186 (11): 1009–1015. DOI: 10.1055/s-0034-1366247.

Dorenkamp M., Sohns C., Vollmann D., L thje L., Seegers J., Wachter R., Puls M., Staab W., Lotz J., Zabel M. Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation: role of transesophageal echocardiography and multidetector computed tomography. Int. J. Cardiol. 2013; 163 (1): 26–33. DOI: 10.1016/j.ijcard.2011.06.124.

Kantarci M., Sade R., Colak A. Assessment of atrial appendage stasis and thrombosis using MDCT. Nat. Rev. Cardiol. 2015; 12 (6): 374. DOI:10.1038/nrcardio.2014.77-c1.

Sorgente A., Chierchia G.B., de Asmundis C., Sarkozy A., Capulzini L., Brugada P. Complications of atrial fibrillation ablation: when prevention is better than cure. Europace. 2011; 13 (11): 1526–1532. DOI: 10.1093/europace/eur209.

Cappato R., Calkins H., Chen S.A., Davies W., Iesaka Y., Kalman J., Kim Y.H., Klein G., Natale A., Packer D., Skanes A., Ambrogi F., Biganzoli E. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ. Arrhythm. Electrophysiol. 2010; 3 (1): 32–38. DOI: 10.1161/CIRCEP.109.859116.

Piorkowski C., Hindricks G., Schreiber D., Tanner H., Weise W., Koch A., Gerds-Li J.H., Kottkamp H. Electroanatomic reconstruction of the left atrium, pulmonary veins, and esophagus compared with the “true anatomy” on multislice computed tomography in patients undergoing catheter ablation of atrial fibrillation. Heart Rhythm. 2006; 3 (3): 317– 327.

Lemola K., Sneider M., Desjardins B., Case I., Han J., Good E., Tamirisa K., Tsemo A., Chugh A., Bogun F., Pelosi F.Jr., Kazerooni E., Morady F., Oral H. Computed tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation. 2004; 110 (24): 3655–3660.

Maeda S., Iesaka Y., Uno K., Otomo K., Nagata Y., Suzuki K., Hachiya H., Goya M., Takahashi A., Fujiwara H., Hiraoka M., Isobe M. Complex anatomy surrounding the left atrial posterior wall: analysis with 3D computed tomography. Heart Vessels. 2012; 27 (1): 58–64. DOI: 10.1007/s00380-011-0120-x. Epub 2011 Feb 18.

Pollak S.J., Monir G., Chernoby M.S., Elenberger C.D. Novel imaging techniques of the esophagus enhancing safety of left atrial ablation. J. Cardiovasc. Electrophysiol. 2005; 16 (3): 244–248.

Good E., Oral H., Lemola K., Han J., Tamirisa K., Igic P., Elmouchi D., Tschopp D., Reich S., Chugh A., Bogun F., Pelosi F. Jr., Morady F. Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. J. Am. Coll. Cardiol. 2005; 46 (11): 2107–2110.

Pappone C., Oral H., Santinelli V., Vicedomini G., Lang C.C., Manguso F., Torracca L., Benussi S., Alfieri O., Hong R., Lau W., Hirata K., Shikuma N., Hall B., Morady F. Atrio- esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation. 2004; 109 (22): 2724–2726.

Saad E.B., Rossillo A., Saad C.P., Martin D.O., Bhargava M., Erciyes D., Bash D., Williams- Andrews M., Beheiry S., Marrouche N.F., Adams J., Pisanò E., Fanelli R., Potenza D., Raviele A., Bonso A., Themistoclakis S., Brachmann J., Saliba W.I., Schweikert R.A., Natale A. Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation. 2003; 108 (25): 3102–3107.

European Heart Rhythm Association (EHRA); European Cardiac Arrhythmia Soсiety (ECAS); American College of Cardiology (ACC); American Heart Association (AHA); Society of Thoracic Surgeons (STS), Calkins H., Brugada J., Packer D.L., Cappato R., Chen S.A., Crijns H.J., Damiano RJ. Jr., Davies D.W., Haines D.E., Haissaguerre M., Iesaka Y., Jackman W., Jais P., Kottkamp H., Kuck K.H., Lindsay B.D., Marchlinski F.E., McCarthy P.M., Mont J.L., Morady F., Nademanee K., Natale A., Pappone C., Prystowsky E., Raviele A., Ruskin J.N., Shemin R.J. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2007; 4 (6): 816–861.

Packer D.L., Keelan P., Munger T.M., Breen J.F., Asirvatham S., Peterson L.A., Monahan K.H., Hauser M.F., Chandrasekaran K., Sinak L.J., Holmes D.R. Jr. Clinical presentation, investigation, and management of pulmonary vein stenosis complicating ablation for atrial fibrillation. Circulation. 2005; 111 (5): 546–554. DOI: 10.1161/01.CIR.0000154541.58478.36.

Holmes D.R. Jr., Monahan K.H., Packer D. Pulmonary vein stenosis complicating ablation for atrial fibrillation: clinical spectrum and interventional considerations. JACC Cardiovasc. Interv. 2009; 2 (4): 267–276. DOI: 10.1016/j.jcin.2008.12.014.

Raviele A., Natale A., Calkins H., Camm J.A., Cappato R., Ann Chen S., Connolly S.J., Damiano R. Jr., DE Ponti R., Edgerton J.R., Haïssaguerre M., Hindricks G., Ho S.Y., Jalife J., Kirchhof P., Kottkamp H., Kuck K.H., Marchlinski F.E., Packer D.L., Pappone C., Prystowsky E., Reddy V.K., Themistoclakis S., Verma A., Wilber D.J., Willems S. Venice Chart. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J. Cardiovasc. Electrophysiol. 2012; 23 (8): 890–923. DOI: 10.1111/j.1540-8167.2012.02381.x.

Horton R., Di Biase L., Reddy V., Neuzil P., Mohanty P., Sanchez J., Nguyen T., Mohanty S., Gallinghouse G.J., Bailey S.M., Zagrodzky J.D., Burkhardt J.D., Natale A. Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomographic

angiography: implications for balloon-based procedures. Heart Rhythm. 2010; 7 (7): 937–941. DOI: 10.1016/j.hrthm.2010.03.027.

Canpolat U., Aytemir K., Hızal M., Hazırolan T., Yorgun H., Sahiner L., Kaya E.B., Oto A. Imaging before cryoablation of atrial fibrillation: is phrenic nerve palsy predictable? Europace. 2014; 16 (4): 505–510. DOI: 10.1093/europace/eut155.

The authors declare that there are no conflicts of interest present.