A new approach for contrast-enhanced X-ray imaging of the left atrium and pulmonary veins for atrial fibrillation ablation: rotational angiography during adenosine-induced asystole

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Abstract
Atrial fibrillation ablation is a complex procedure that requires detailed anatomic information about left atrium (LA) and pulmonary veins (PVs). The goal of this study was to test rotational angiography of the LA during adenosine-induced asystole as an imaging tool in patients undergoing atrial fibrillation ablation. Seventy patients with paroxysmal or persistent atrial fibrillation undergoing PV isolation were included. After transseptal puncture, adenosine (30 mg) was given intravenously, and during atrioventricular block, contrast medium was directly injected in the LA; a rotational angiography was performed (right anterior oblique 55° to left anterior oblique 55°). Rotational angiography images were assessed qualitatively in all patients and quantitatively in 45 patients in comparison with computed tomography (CT) images. The majority of rotational angiography imaging data (94%) were deemed at least ‘useful’ in delineating the LA–PV anatomy. The so-called ‘ridge’ between left superior PV and left atrial appendage was delineated in 90% of the patients. All accessory PVs were independently identified by rotational angiography and CT. A blinded quantitative comparison of PV ostial diameters showed an excellent correlation between rotational angiography and CT measurements ( r > 0.90 for all PVs). No serious adverse effects occurred in association with adenosine. Intra-procedural contrast-enhanced rotational angiography of the LA–PV during adenosine-induced asystole is feasible and provides anatomical information of high diagnostic value for atrial fibrillation ablation.