Recent advances in cardiac electrophysiology with revolutionary development of transcutaneous procedures have required electrophysiologists to have precise knowledge of the spatial anatomy of the heart, and thus, led to the increasing use of cardiac imaging procedures such as multidetector CT (MDCT). The introduction of 64-detector (and higher) scanners has made it possible to visualize the anatomic landmarks that are essential for both diagnostic and therapeutic cardiac procedures and, in selected cases, prevention of procedure-related complications. Future work with these emerging imaging techniques will further characterize how cardiac CT can aid cardiologists to dissect the microscopic anatomy of the heart, optimize success rates, and potentially minimize inherent risks of the cardiac interventions. In this review, we focus on the latest developments in the application of MDCT for electrophysiologic interventions.
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References and Recommended Reading
Morady F: Radio-frequency ablation as treatment for cardiac arrhythmias. N Engl J Med 1999, 340:534–544.
Yee R, Connolly S, Noorani H: Clinical review of radiofrequency catheter ablation for cardiac arrhythmias. Can J Cardiol 2003, 19:1273–1284.
d’Avila A, Houghtaling C, Gutierrez P, et al.: Catheter ablation of ventricular epicardial tissue: a comparison of standard and cooled-tip radiofrequency energy. Circulation 2004, 109:2363–2369.
Giorgberidze I, Saksena A, Kroll RB, et al.: Efficacy and safety of radiofrequency catheter ablation of left-sided accessory pathways through the coronary sinus. Am J Cardiol 1995, 76:359–365.
Saremi F, Krishnan S: Cardiac conduction system: anatomic landmarks relevant to interventional electrophysiologic techniques demonstrated with 64-detector CT. Radiographics 2007, 27:1539–1565.
Dong J, Calkins H, Solomon SB, et al.: Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations. Circulation 2006, 113:186–194.
Vyselaar JR, Michael KA, Nolan RL, et al.: Left subclavian vein occlusion after pacemaker insertion. Cardiovasc J Afr 2008, 19:155.
Graham LN, Melton IC, MacDonald S, et al.: Value of CT localization of the fossa ovalis prior to transseptal left heart catheterization for left atrial ablation. Europace 2007, 9:417–423.
Saremi F, Attai SF, Narula J: 64 multidetector CT in patent foramen ovale. Heart 2007, 93:505.
Anderson RH, Brown NA, Webb S: Development and structure of the atrial septum. Heart 2002, 88:104–110.
Shirani J, Roberts WC: Clinical, electrocardiograhic and morphologic features of massive fatty deposits (lipomatous hypertrophy) in the atrial septum. J Am Coll Cardiol 1993, 22:226–238.
Saremi F, Pourzand L, Krishnan S, et al.: Right atrial cavotricuspid isthmus: anatomic characterization with multi-detector row CT. Radiology 2008, 247:658–668.
Patanè S, Anfuso C, Marte F: An unusual presentation of a right atrial Chiari network. Int J Cardiol 2009, 132:e28–e30.
Corcoran SJ, Lawrence C, McGuire MA: The valve of Vieussens: an important cause of difficulty in advancing catheters into the cardiac veins. J Cardiovasc Electrophysiol 1999, 10:804–808.
Shah D, Haissaguerre M, Jais P, Hocini M: Nonpulmonary vein foci: do they exist? Pacing Clin Electrophysiol 2003, 26:1631–1635.
de Oliveira IM, Scanavacca MI, Correia AT, et al.: Anatomic relations of the Marshall vein: importance for catheterization of the coronary sinus in ablation procedures. Europace 2007, 9:915–919.
Saremi F, Gurudevan SV, Narula J, Abolhoda A: Multidetector computed tomography (MDCT) in diagnosis of “cor triatriatum sinister.” J Cardiovascular Comput Tomogr 2007, 1:172–174.
Haramati LB, Moche IE, Rivera VT, et al.: Computed tomography of partial anomalous pulmonary venous connection in adults. J Comput Assist Tomogr 2003, 27:743–749.
Calkins H, Brugada J, Packer DL, et al.; Heart Rhythm Society; European Heart Rhythm Association; European Cardiac Arrhythmia Society; American College of Cardiology; American Heart Association; Society of Thoracic Surgeons: 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 developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace 2007, 9:335–379.
Haissaguerre M, Jais P, Shah DC, et al.: Spontaneous initiation of AF by ectopic beats originating in the pulmonary veins. N Engl J Med 1998, 339:659–666.
Pappone C, Oreto G, Rosanio S, et al.: Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001, 104:2539–2544.
Anderson RH, Brown NA: The anatomy of the heart revisited. Anat Rec 1996, 246:1–7.
Choi SI, Seo JB, Choi SH, et al.: Variation of the size of pulmonary venous ostia during the cardiac cycle: optimal reconstruction window at ECG-gated multi-detector row CT. Eur Radiol 2005, 15:1441–1445.
Scharf C, Sneider M, Case I, et al.: Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography. J Cardiovasc Electrophysiol 2003, 14:150–155.
Cronin P, Sneider MB, Kazerooni EA, et al.: MDCT of the left atrium and pulmonary veins in planning radiofrequency ablation for atrial fibrillation: a how-to guide. AJR Am J Roentgenol 2004, 183:767–778.
Marom EM, Herndon JE, Kim YH, et al.: Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology 2004, 230:824–829.
Sánchez-Quintana D, Cabrera JA: Anatomic relations between the esophagus and left atrium and relevance for ablation of atrial fibrillation. Circulation 2005, 112:1400–1405.
Cury RC, Abbara S, Schmidt S, et al.: Relationship of the esophagus and aorta to the left atrium and pulmonary veins: implications for catheter ablation of atrial fibrillation. Heart Rhythm 2005, 2:1317–1323.
Sacher F, Jais P, Stephenson K, et al.: Phrenic nerve injury after catheter ablation of atrial fibrillation. Indian Pacing Electrophysiol J 2007, 7:1–6.
Sánchez-Quintana D, Cabrera JA, Climent V, et al.: How close are the phrenic nerves to cardiac structures? Implications for cardiac interventionalists. J Cardiovasc Electrophysiol 2005, 16:309–313.
Takahashi A, Kuwahara T, Takahashi Y: Complications in the catheter ablation of atrial fibrillation: incidence and management. Circ J 2009, 73:221–226.
Saremi F, Channual S, Gurudevan SV, et al.: Prevalence of left atrial appendage pseudothrombus filling defects in patients with atrial fibrillation undergoing coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2008, 2:164–171.
Lemola K, Sneider M, Desjardins B, et al.: Computed tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation 2004, 110:3655–3660.
Saad EB, Rossillo A, Saad CP, et al.: Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation 2003, 108:3102–3107.
Sacher F, Monahan KH, Thomas SP, et al.: Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study. J Am Coll Cardiol 2006, 47:2498–2503.
Matsumoto Y, Krishnan S, Fowler SJ, et al.: Detection of phrenic nerves and their relation to cardiac anatomy using 64-slice multidetector computed tomography. Am J Cardiol 2007, 100:133–137.
Cabrera JA, Sanchez-Quintana D, Farre J, et al.: The inferior right atrial isthmus: further architectural insights for current and coming ablation technologies. J Cardiovasc Electrophysiol 2005, 16:409–410.
Eckardt L, Breithardt G: Catheter ablation of ventricular tachycardia. From indication to three-dimensional mapping technology. Herz 2009, 34:187–196.
Bogun FM, Desjardins B, Good E, et al.: Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol 2009, 53:1138–1145.
Raney AR, Saremi F, Kenchaiah S, et al.: Multidetector computed tomography shows intramyocardial fat deposition. J Cardiovasc Comput Tomogr 2008, 2:152–163.
Abbara S, Desai JC, Cury RC, et al.: Mapping epicardial fat with multi-detector computed tomography to facilitate percutaneous transepicardial arrhythmia ablation. Eur J Radiol 2006, 57:417–422.
Hong KN, Russo MJ, Liberman EA, et al.: Effect of epicardial fat on ablation performance: a three-energy source comparison. J Card Surg 2007, 22:521–524.
Sá MI, de Roos A, Westenberg JJ, et al.: Imaging techniques in cardiac resynchronization therapy. Int J Cardiovasc Imaging 2008, 24:89–105.
Rosamond T, Wetzel LH, Lakkireddy D, et al.: IntraCameral right coronary artery: detection by 64 slice coronary computed tomographic angiography and implications for radiofrequency ablation of atrial dysrhythmias. Pacing Clin Electrophysiol 2007, 30:1571–1574.
Saremi F, Channual S, Abolhoda A, et al.: MDCT of the Sshaped sinoatrial node artery. AJR Am J Roentgenol 2008, 190:1569–1575.
Mühlenbruch G, Koos R, Wildberger JE, et al.: Imaging of the cardiac venous system: comparison of MDCT and conventional angiography. AJR Am J Roentgenol 2005, 185:1252–1257.
Kuo JY, Chen SA: Is vagal denervation a good alternative or just adjunctive to pulmonary vein isolation in catheter ablation of atrial fibrillation? J Am Coll Cardiol 2007, 49:1349–1351.
Pauza DH, Skripka V, Pauziene N, et al.: Morphology, distribution, and variability of the epicardiac neural ganglionated subplexuses in the human heart. Anat Rec 2000, 259:353–382.
Ypenburg C, van der Wall EE, Schalij MJ, et al.: Imaging in cardiac resynchronisation therapy. Neth Heart J 2008, 16(Suppl 1):S36–S40.
Saremi F, Abolhoda A, Ashikyan O, et al.: Arterial supply to sinuatrial and atrioventricular nodes: imaging with multidetector CT. Radiology 2008, 246:99–107.
Lemery R, Guiraudon G, Veinot JP: Anatomic description of the Bachmann’s bundle and its relation to the atrial septum. Am J Cardiol 2003, 91:1482–1485.
Saremi F, Channual S, Krishnan S, et al.: Bachmann bundle and its arterial supply: imaging with multidetector CT—implications for interatrial conduction abnormalities and arrhythmias. Radiology 2008, 248:447–457.
Chauvin M, Shah DC, Haïssaguerre M, et al.: The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans. Circulation 2000, 101:647–652.
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Saremi, F., Dang, T. CT-guided cardiac electrophysiology. curr cardiovasc imaging rep 2, 437–446 (2009). https://doi.org/10.1007/s12410-009-0055-0
- Inferior Vena Cava
- Pulmonary Vein
- Left Atrium
- Coronary Sinus
- Catheter Ablation