No conflict of interest.
Impact of Cardiac Computed Tomography of the Interatrial Septum before Pulmonary Vein Isolation
Article first published online: 16 MAY 2013
©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 10, pages 1245–1250, October 2013
How to Cite
KOBZA, R., SCHOENENBERGER, A. W., CUCULI, F., ZUBER, M., AUF DER MAUR, C., BUHMANN, R., RESINK, T. J. and ERNE, P. (2013), Impact of Cardiac Computed Tomography of the Interatrial Septum before Pulmonary Vein Isolation. Pacing and Clinical Electrophysiology, 36: 1245–1250. doi: 10.1111/pace.12157
- Issue published online: 8 OCT 2013
- Article first published online: 16 MAY 2013
- Manuscript Accepted: 7 MAR 2013
- Manuscript Revised: 6 MAR 2013
- Manuscript Received: 19 NOV 2012
- atrial fibrillation;
- patent foramen ovale;
- pulmonary vein isolation
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).
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.