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Impact of Cardiac Computed Tomography of the Interatrial Septum before Pulmonary Vein Isolation
Author(s) -
KOBZA RICHARD,
SCHOENENBERGER ANDREAS W.,
CUCULI FLORIM,
ZUBER MICHEL,
AUF DER MAUR CHRISTOPH,
BUHMANN RALF,
RESINK THERESE J.,
ERNE PAUL
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12157
Subject(s) - medicine , interatrial septum , pulmonary vein , radiology , atrial fibrillation , patent foramen ovale , multidetector computed tomography , gold standard (test) , cardiology , receiver operating characteristic , computed tomography , predictive value , transesophageal echocardiogram , confidence interval , catheter ablation , left atrium , percutaneous
Background Multidetector computed tomography (MDCT) may be useful to identify patients with patent foramen ovale (PFO). The aim of this study was to analyze whether a MDCT performed before pulmonary vein isolation reliably detects a PFO that may be used for access to the left atrium. Methods and Results In 79 consecutive patients, who were referred for catheter ablation of symptomatic paroxysmal or persistent atrial fibrillation (AF), the presence of a PFO was explored by MDCT and transesophageal echocardiography (TEE). TEE was considered as the gold standard, and quality of TEE was good in all patients. In 16 patients (20.3%), MDCT could not be used for analysis because of artifacts, mainly because of AF. On TEE, a PFO was found in 15 (23.8%) of the 63 patients with usable MDCT. MDCT detected six PFO of which four were present on TEE. This corresponded to a sensitivity of 26.7%, a specificity of 95.8%, a negative predictive value of 80.7%, and a positive predictive value of 66.7%. The receiver operating characteristics curve of MDCT for the detection of PFO was 0.613 (95% confidence interval 0.493–0.732). Conclusions MDCT may detect a PFO before pulmonary isolation. However, presence of AF may lead to artifacts on MDCT impeding a meaningful analysis. Furthermore, in this study sensitivity and positive predictive value of MDCT were low and therefore MDCT was not a reliable screening tool for detection of PFO.