The role of coronary CT angiography in advanced pericoronary adipose tissue analysis and planning of atrial fibrillation ablation procedure
Boussoussou Melinda
Theoretical and Translational Medicine
Dr. Kellermayer Miklós
SE Városmajori Szív- és Érgyógyászati Klinika
2024-04-25 14:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Maurovich-Horvat Pál és Szilveszter Bálint
Dr. Kolozsvári Rudolf
Dr. Jenei Zsigmond Máté
Dr. Karádi István
Dr. Keltai Katalin
Dr. Sármán Balázs
Pericoronary adipose tissue analysis
CCTA-based PCAT markers (PCAT attenuation and gradient) as coronary inflammation biomarkers seem to play an essential role in the identification of patients at CAD risk. Although, PCAT markers might be affected by several patient and image acquisition parameters that are taken into account differently in the scientific literature. Therefore, our aim was to determine the effect of patient and imaging characteristics on the association between a low-cardiovascular-risk patient population and PCAT markers. In our retrospective, single-centre analysis, we enrolled stable chest pain patients with zero calcium scores on CCTA. The images were analyzed for the presence of NCP, obstructive stenosis, SSS, SIS, and HRP. Overall, 1652 patients’ scans were analyzed with an addition of 330-330 patients’ scans as validation cohorts. Based on our study results, patient and image acquisition parameters have a significant effect on PCAT markers, and they represent a wide range of values in the low cardiovascular-risk patient population. The association between PCAT markers and CAD characteristics after the correction of the above-mentioned parameters disappeared. This highlights the importance of evaluating PCAT markers by correcting for all possible confounders in the future.
Left atrial wall thickness and pulmonary vein analysis
A novel contact-force guided ablation technique called the modified CLOSE protocol for the enclosure of pulmonary veins is used for treating AF. Using this technique in our prospective, single-centre study, the aim was to define whether LAWT has an influence on the success rate of first-pass PVI. Symptomatic, drug-refractory AF patients were enrolled consecutively who underwent initial radiofrequency catheter ablation with the use of the modified CLOSE protocol after a pre-procedural CCTA. Our analysis was based on 1034 LAWT and 376 PV measurements in 94 patients. Based on our study results, with the modified CLOSE protocol, a high acute procedural success was present in persistent and paroxysmal AF patients, independently from CCTA-derived LAWT.
Furthermore, regarding PV anatomy, a larger RSPV diameter had a positive influence on the right-sided first-pass isolation rate.
