Optimized Computed Tomography Acquisition Protocol for Ethanol Infusion Into the Vein of Marshall.
ablation
computed tomography
ethanol infusion into the vein of Marshall
vein of Marshall
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
03
06
2021
revised:
03
09
2021
accepted:
29
09
2021
entrez:
25
2
2022
pubmed:
26
2
2022
medline:
16
3
2022
Statut:
ppublish
Résumé
This study sought to introduce a computed tomography (CT) protocol for optimal planning of vein of Marshall (VOM) catheterization. Ethanol infusion into the VOM (Et-VOM) is increasingly used in atrial fibrillation ablation. Preprocedural CT was performed with either a conventional (conv-CT; n = 132) or an optimized CT protocol (VOM-CT; n = 126) designed for obtaining on a single image both left atrial and coronary sinus (CS) enhancement. The detection rate and anatomical features of the CT-derived VOM were analyzed and the utility of VOM-CT protocol was assessed by comparing the procedural data. VOM was detected in 35% in conv-CT versus 63% in VOM-CT (P < 0.001). The VOM-CT protocol did not impair the assessment of left atrial anatomy and appendage patency. In VOM-CT, the detection of the VOM was related to body mass index and width of epicardial space on posterior wall. Mean distance between CS ostium and VOM was 36 ± 7 mm. Mean VOM diameter was 1.6 ± 0.3 mm. On the CS circumference, the VOM emerged superiorly in 68% and postero-superiorly in 32%. Ethanol infusion into the VOM was attempted in 165 patients (77 conv-CT, 70 VOM-CT, and 18 without-CT). After registration in CARTO, the VOM segmented on CT matched its location on venography in all cases. As compared with conv-CT and without-CT, procedures guided by VOM-CT showed significantly shorter radiation time, shorter procedure time, lower amount of the contrast medium, and fewer contrast injections to obtain VOM catheterization. The proposed CT protocol allows for improved visualization of the VOM, translating into easier VOM catheterization.
Sections du résumé
OBJECTIVES
This study sought to introduce a computed tomography (CT) protocol for optimal planning of vein of Marshall (VOM) catheterization.
BACKGROUND
Ethanol infusion into the VOM (Et-VOM) is increasingly used in atrial fibrillation ablation.
METHODS
Preprocedural CT was performed with either a conventional (conv-CT; n = 132) or an optimized CT protocol (VOM-CT; n = 126) designed for obtaining on a single image both left atrial and coronary sinus (CS) enhancement. The detection rate and anatomical features of the CT-derived VOM were analyzed and the utility of VOM-CT protocol was assessed by comparing the procedural data.
RESULTS
VOM was detected in 35% in conv-CT versus 63% in VOM-CT (P < 0.001). The VOM-CT protocol did not impair the assessment of left atrial anatomy and appendage patency. In VOM-CT, the detection of the VOM was related to body mass index and width of epicardial space on posterior wall. Mean distance between CS ostium and VOM was 36 ± 7 mm. Mean VOM diameter was 1.6 ± 0.3 mm. On the CS circumference, the VOM emerged superiorly in 68% and postero-superiorly in 32%. Ethanol infusion into the VOM was attempted in 165 patients (77 conv-CT, 70 VOM-CT, and 18 without-CT). After registration in CARTO, the VOM segmented on CT matched its location on venography in all cases. As compared with conv-CT and without-CT, procedures guided by VOM-CT showed significantly shorter radiation time, shorter procedure time, lower amount of the contrast medium, and fewer contrast injections to obtain VOM catheterization.
CONCLUSIONS
The proposed CT protocol allows for improved visualization of the VOM, translating into easier VOM catheterization.
Identifiants
pubmed: 35210073
pii: S2405-500X(21)00913-0
doi: 10.1016/j.jacep.2021.09.020
pii:
doi:
Substances chimiques
Ethanol
3K9958V90M
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
168-178Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures Support was provided by the French National Agency for Research, Equipex-MUSIC ANR-11-EQPX-0030, and IHU-LIRYC ANR-10-IAHU-04. Drs Derval, Pambrun, Duchateau, and Sacher have received consulting fees and speaking honoraria from Biosense Webster. Drs Derval, Sacher, and Jaïs have received speaking honoraria from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.