Imaging Before and After Electrophysiology Procedures



Imaging Before and After Electrophysiology Procedures



Introduction


Pre- or intraprocedural imaging has become integral to electrophysiologists to minimize the risks of invasive and technically difficult electrophysiology (EP) procedures. Postprocedural imaging is also imperative to detect complications. CT and MR are emerging as valuable noninvasive imaging modalities to provide this information, including establishing the etiology, identifying the substrate, prognosis/risk stratification, preprocedural evaluation/mapping, guidance during intervention, and postprocedural assessment.


Transthoracic echocardiography is a 1st-line means to image the heart, given that it is relatively inexpensive, available, and trusted. However, this modality is limited by variability in user skill and acoustic windows in individual patients. Though transesophageal echocardiography (TEE) may increase sensitivity for other cardiac findings, it is more expensive and obviously more invasive than its transthoracic counterpart.






Preprocedural Evaluation and Mapping


Atrial Fibrillation/Flutter Ablation


For atrial fibrillation (AF) ablation, CT and MR provide knowledge on the anatomy and variations of the pulmonary veins, which is essential to ensure that all the ectopic foci are ablated. Variations can be seen in the number, branching pattern, and length. Accessory ostium (1.6-19%) and common ostium (2.4-25%) are the common variations. Knowledge of ostial orientation and distances of the branches from the ostia is essential to avoid branch vessel stenosis. Pulmonary vein stenosis and thrombus are contraindications for the procedure. The location of the esophagus relative to the pulmonary vein ostia has the potential to minimize iatrogenic esophageal injury.


MR can also evaluate left atrial (LA) volume and function, which indicate persistent AF. The extent of LGE is a predictor of the type of AF (paroxysmal vs. persistent) and the recurrence of AF. Postcontrast T1 MR has also been used for the same purpose.





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Apr 6, 2020 | Posted by in CARDIOVASCULAR IMAGING | Comments Off on Imaging Before and After Electrophysiology Procedures

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