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. 2022 Mar 1;12(3):612.
doi: 10.3390/diagnostics12030612.

Reduced Radiation Exposure Protocol during Computer Tomography of the Left Atrium Prior to Catheter Ablation in Patients with Atrial Fibrillation

Tomasz Jadczyk  1   2 , Jiri Wolf  1   3 , Martin Pesl  1   3   4 , Filip Soucek  1   3 , Frantisek Lehar  1   3 , Jiri Jez  1   3 , Tomas Kulik  1   3 , Bohdan Tyshchenko  5 , Silvie Belaskova  5   6 , Petr Ourednicek  6   7 , Guido Caluori  1   8   9   10 , Miroslav Novak  3 , Zdenek Starek  1   3
Affiliations

Reduced Radiation Exposure Protocol during Computer Tomography of the Left Atrium Prior to Catheter Ablation in Patients with Atrial Fibrillation

Tomasz Jadczyk et al. Diagnostics (Basel). .

Abstract

(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.

Keywords: catheter ablation; computed tomography; radiation.

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Conflict of interest statement

Petr Ourednicek is a clinical scientist at Philips, Best, The Netherlands. Other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Examples of LA images performed using Group A–D scanning protocols. 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) was used with tube current of 33 mAs, 67 mAs, 135 mAs and 600 mAs for Group A–D, respectively.
Figure 2
Figure 2
(a) Dual surview (scout in the two cross-sections); (b) ultra-low-dose calcium scoring; (c) setting of contrast agent tracker.
Figure 3
Figure 3
Parallel views of 3D electroanatomical maps with CT-generated LA models. From left to right, each subfigure represents the patient’s electroanatomical maps (beige with PVs colorized), the corresponding CT LA model (red) and the fusion of the two. (a) Group A (current tube 33 mAs); (b) Group B (current tube 67 mAs); (c) Group C (current tube 135 mAs); (d) Group D (current tube 600 mAs).
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