Gianluca Pontone MD, Presenter: Speakers Bureau, General Electric Company Consultant, General Electric Company Research Consultant, HeartFlow, Inc Speakers Bureau, HeartFlow, Inc Speakers Bureau, Medtronic, Inc Speakers Bureau, Bayer AG

Erika Bertella, Abstract Co-Author: Nothing to Disclose

Maria Petulla, Abstract Co-Author: Nothing to Disclose

Eleonora Russo, Abstract Co-Author: Nothing to Disclose

Ester Innocenti, Abstract Co-Author: Nothing to Disclose

Andrea Baggiano, Abstract Co-Author: Nothing to Disclose

Saima Mushtaq, Abstract Co-Author: Nothing to Disclose

Paola Gripari, Abstract Co-Author: Nothing to Disclose

Daniele Andreini MD, Abstract Co-Author: Consultant, General Electric Company

claudio tondo, Abstract Co-Author: Advisory Board, Medtronic, Inc Speaker, St. Jude Medical, Inc Consultant, St. Jude Medical, Inc Speaker, Johnson & Johnson Consultant, Johnson & Johnson

The aim of this study is to compare the procedural characteristics, overall radiation exposure and clinical outcomes between radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) guided by image integration with CCT versus CMR.

400 consecutive patients with drug-refractory paroxysmal or persistent AF were randomized to CT (Group 1; N: 200; mean age 61.6±10.9 yo; male:155) or MR (Group 2; N: 200; mean age 59.7±10.4 yo; male:166) for evaluation of LA before RFCA. CT was performed with 64-slices scanner (Discovery CT 750HD, GE Healthcare, Milwaukee, WI) and MR was performed with 1.5-T scanner (Discovery MR450, GE Healthcare, Milwaukee, WI) using a non-triggered contrast enhancement MR angiography sequence. All patients were treated by image integration-supported RFCA. LA diameter, LA volume, pulmonary veins anatomy and ostial dimensions, procedural characteristics, overall radiation exposure and rate of AF recurrence were measured in the two groups.

The two groups were homogeneous in terms of demographic characteristics, cardiovascular risk factors, prevalence of persistent AF, medical therapy and echocardiographic characteristics. The mean follow-up was similar (557±302 vs 523±265 days, respectively, p:0.24). Group 1 showed higher LA volume versus group 2 (117±46 vs 101±40 mL, p<0.001). The procedural characteristics [fluoroscopy time (32.6±16.0 vs 35.0±16.6 min, p:0.15); procedural duration (180.2±59.0 vs 182.8±53.5, p:0.65, pulmonary veins identified (4±0.1 vs. 3.9±0.2, p:0.08); pulmonary veins targeted (3.9±0.4 vs 3.9±0.4, p: 053); pulmonary veins isolated (3.9±0.4 vs 3.9±0.4, p:0.9)] and the rate of AF recurrence (29% vs 26%, p:0.5) were similar between the two groups. Group 1 showed a higher overall cumulative radiation exposure (40.4±23.7 vs 32.8±23.5, p<0.005). and LA volume measured by MR was the most robust independent predictor of AF recurrence at multivariate analysis [(HR: 1.08 (1.01-1.15), p:0.02].

MR integration-supported RFCA procedure seems to be associated with a lower overall cumulative radiation despite similar outcome in comparison with CT-guided RFCA.

MR imaging is a good guide for atrial fibrilation ablation procedure

Pontone, G, Bertella, E, Petulla, M, Russo, E, Innocenti, E, Baggiano, A, Mushtaq, S, Gripari, P, Andreini, D, tondo, c, Cardiac Computed Tomography versus Cardiac Magnetic Resonance for Characterization of Left Atrium Anatomy before Radiofrequency Catheter Ablation of Atrial Fibrillation: Impact on Radiation Exposure and Outcome.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010590.html