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

Aims: Atrial fibrillation ablation is a complex procedure that requiresdetailed anatomic information about left atrium (LA) and pulmonaryveins (PVs). The goal of this study was to test rotational angiographyof the LA during adenosine-induced asystole as an imaging toolin patients undergoing atrial fibrillation ablation. Methods and results: Seventy patients with paroxysmal or persistent atrial fibrillationundergoing PV isolation were included. After transseptal puncture,adenosine (30 mg) was given intravenously, and during atrioventricularblock, contrast medium was directly injected in the LA; a rotationalangiography was performed (right anterior oblique 55° toleft anterior oblique 55°). Rotational angiography imageswere assessed qualitatively in all patients and quantitativelyin 45 patients in comparison with computed tomography (CT) images.The majority of rotational angiography imaging data (94%) weredeemed at least ‘useful’ in delineating the LA–PVanatomy. The so-called ‘ridge’ between left superiorPV and left atrial appendage was delineated in 90% of the patients.All accessory PVs were independently identified by rotationalangiography and CT. A blinded quantitative comparison of PVostial diameters showed an excellent correlation between rotationalangiography and CT measurements (r > 0.90 for all PVs). Noserious adverse effects occurred in association with adenosine. Conclusion: Intra-procedural contrast-enhanced rotational angiography ofthe LA–PV during adenosine-induced asystole is feasibleand provides anatomical information of high diagnostic valuefor atrial fibrillation ablation.