Source of Funding: This work was made possible by grant number KL2 RR024130 (GMM) from the National Center for Research Resources (NCRR), a component of the NIH.
Use of Computed Tomography to Identify Atrial Fibrillation Associated Differences in Left Atrial Wall Thickness and Density
Article first published online: 27 OCT 2012
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 1, pages 55–62, January 2013
How to Cite
DEWLAND, T. A., WINTERMARK, M., VAYSMAN, A., SMITH, L. M., TONG, E., VITTINGHOFF, E. and MARCUS, G. M. (2013), Use of Computed Tomography to Identify Atrial Fibrillation Associated Differences in Left Atrial Wall Thickness and Density. Pacing and Clinical Electrophysiology, 36: 55–62. doi: 10.1111/pace.12028
Disclosures: Dr. Marcus has received research funding from Baylis Medical, St. Jude Medical, and SentreHeart; is a consultant for InCarda Cardiotherapeutics; and has received speaker fees from St. Jude Medical.
- Issue published online: 9 JAN 2013
- Article first published online: 27 OCT 2012
- Manuscript Accepted: 21 AUG 2012
- Manuscript Revised: 14 AUG 2012
- Manuscript Received: 21 JUN 2012
- National Center for Research Resources. Grant Number: KL2 RR024130
- atrial fibrillation;
- computed tomography
Left atrial (LA) tissue characteristics may play an important role in atrial fibrillation (AF) induction and perpetuation. Although frequently used in clinical practice, computed tomography (CT) has not been employed to describe differences in LA wall properties between AF patients and controls. We sought to noninvasively characterize AF-associated differences in LA tissue using CT.
CT images of the LA were obtained in 98 consecutive patients undergoing AF ablation and in 89 controls. A custom software algorithm was used to measure wall thickness and density in four prespecified regions of the LA.
On average, LA walls were thinner (−15.5%, 95% confidence interval [CI] −23.2 to −7.8%, P < 0.001) and demonstrated significantly lower density (−19.7 Hounsfield Units [HU], 95% CI −27.0 to −12.5 HU, P < 0.001) in AF patients compared to controls. In linear mixed models adjusting for demographics, clinical variables, and other CT measurements, the average LA, interatrial septum, LA appendage, and anterior walls remained significantly thinner in AF patients. After adjusting for the same potential confounders, history of AF was associated with reduced density in the LA anterior wall and increased density below the right inferior pulmonary vein and in the LA appendage.
Application of an automated measurement algorithm to CT imaging of the atrium identified significant thinning of the LA wall and regional alterations in tissue density in patients with a history of AF. These findings suggest differences in LA tissue composition can be noninvasively identified and quantified using CT.
(PACE 2013; 36:55–62)