Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation
Introduction: Preprocedural cardiovascular magnetic resonance (CMR) or computed tomography (CT) imaging of the left atrium/pulmonary veins is usually employed to guide catheter ablation of atrial fibrillation (AFCA). Incidental findings (IFs) are common on cardiac imaging prior to AFCA. However, pre...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-02-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235290672100227X |
| _version_ | 1798024788247052288 |
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| author | Micaela Ebert Rebekka Karrengarn Cosima Jahnke Simon Kircher Sabrina Oebel Michael Döring Gerhard Hindricks Ingo Paetsch Sergio Richter |
| author_facet | Micaela Ebert Rebekka Karrengarn Cosima Jahnke Simon Kircher Sabrina Oebel Michael Döring Gerhard Hindricks Ingo Paetsch Sergio Richter |
| author_sort | Micaela Ebert |
| collection | DOAJ |
| description | Introduction: Preprocedural cardiovascular magnetic resonance (CMR) or computed tomography (CT) imaging of the left atrium/pulmonary veins is usually employed to guide catheter ablation of atrial fibrillation (AFCA). Incidental findings (IFs) are common on cardiac imaging prior to AFCA. However, previous studies have mainly focused on extracardiac IFs detected on CT scan. We aimed to assess the prevalence of relevant cardiac and extracardiac IFs on routine preprocedural CMR in a large patient cohort scheduled for first-time AFCA and report its impact on clinical decision-making and management. Methods and results: We included 2000 consecutive patients (62 ± 10 years; 59% male) who underwent CMR prior to first-time AFCA between April 2015 and March 2019. Among these patients 172 (8.6%) had a total of 184 major IFs. Detection of major IFs resulted in cancellation of the scheduled AFCA procedure in 88 patients (4.4%). Forty-two patients (2.1%) have never been ablated, 46 (2.3%) underwent postponed AFCA after a median time of 83 (32–213) days. The remaining 84 patients (4.2%) underwent an individualized approach to AFCA. The most common major IFs were accessory or anomalous PVs in 76 (3.8%), extracardiac abnormalities suspicious of malignancy in 29 (1.5%), and positive stress perfusion imaging in 19 (7.2% of 261 tested) patients. In 19 patients (1.0%) preprocedural CMR provided the diagnosis of a previously unknown structural cardiac disease. Conclusions: Unexpected relevant findings on routine preprocedural CMR affected clinical decision-making and management in 8.6% of patients scheduled for first-time AFCA. However, whether preprocedural CMR imaging may improve overall clinical outcome needs to be addressed in future research. |
| first_indexed | 2024-04-11T18:08:16Z |
| format | Article |
| id | doaj.art-19a01a3b95e843bbb97b4b3d2fcc27f9 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-04-11T18:08:16Z |
| publishDate | 2022-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-19a01a3b95e843bbb97b4b3d2fcc27f92022-12-22T04:10:13ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672022-02-0138100939Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillationMicaela Ebert0Rebekka Karrengarn1Cosima Jahnke2Simon Kircher3Sabrina Oebel4Michael Döring5Gerhard Hindricks6Ingo Paetsch7Sergio Richter8Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyDepartment of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyDepartment of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyDepartment of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyDepartment of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyDepartment of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyDepartment of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyDepartment of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyCorresponding author at: Department of Electrophysiology, Heart Center - University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, GermanyIntroduction: Preprocedural cardiovascular magnetic resonance (CMR) or computed tomography (CT) imaging of the left atrium/pulmonary veins is usually employed to guide catheter ablation of atrial fibrillation (AFCA). Incidental findings (IFs) are common on cardiac imaging prior to AFCA. However, previous studies have mainly focused on extracardiac IFs detected on CT scan. We aimed to assess the prevalence of relevant cardiac and extracardiac IFs on routine preprocedural CMR in a large patient cohort scheduled for first-time AFCA and report its impact on clinical decision-making and management. Methods and results: We included 2000 consecutive patients (62 ± 10 years; 59% male) who underwent CMR prior to first-time AFCA between April 2015 and March 2019. Among these patients 172 (8.6%) had a total of 184 major IFs. Detection of major IFs resulted in cancellation of the scheduled AFCA procedure in 88 patients (4.4%). Forty-two patients (2.1%) have never been ablated, 46 (2.3%) underwent postponed AFCA after a median time of 83 (32–213) days. The remaining 84 patients (4.2%) underwent an individualized approach to AFCA. The most common major IFs were accessory or anomalous PVs in 76 (3.8%), extracardiac abnormalities suspicious of malignancy in 29 (1.5%), and positive stress perfusion imaging in 19 (7.2% of 261 tested) patients. In 19 patients (1.0%) preprocedural CMR provided the diagnosis of a previously unknown structural cardiac disease. Conclusions: Unexpected relevant findings on routine preprocedural CMR affected clinical decision-making and management in 8.6% of patients scheduled for first-time AFCA. However, whether preprocedural CMR imaging may improve overall clinical outcome needs to be addressed in future research.http://www.sciencedirect.com/science/article/pii/S235290672100227XAtrial fibrillationCatheter ablationCardiac imagingCardiovascular magnetic resonanceIncidental finding |
| spellingShingle | Micaela Ebert Rebekka Karrengarn Cosima Jahnke Simon Kircher Sabrina Oebel Michael Döring Gerhard Hindricks Ingo Paetsch Sergio Richter Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation International Journal of Cardiology: Heart & Vasculature Atrial fibrillation Catheter ablation Cardiac imaging Cardiovascular magnetic resonance Incidental finding |
| title | Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation |
| title_full | Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation |
| title_fullStr | Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation |
| title_full_unstemmed | Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation |
| title_short | Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation |
| title_sort | major incidental findings on routine cardiovascular magnetic resonance imaging prior to first time catheter ablation of atrial fibrillation |
| topic | Atrial fibrillation Catheter ablation Cardiac imaging Cardiovascular magnetic resonance Incidental finding |
| url | http://www.sciencedirect.com/science/article/pii/S235290672100227X |
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