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Coronary computed tomography angiography in a patient with atrial fibrillation, case report
Ahmed Alsaileek1, Mohsen Alharthi, Mouaz Almallah
1King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia.
Insights
Coronary computed tomography angiography (CCTA) can provide diagnostic image quality in patients with atrial fibrillation (AF) using advanced reconstruction algorithms. This technique is valuable for assessing coronary arteries in complex cardiac conditions.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Cardiac Arrhythmias
Background:
- Atrial fibrillation (AF) is a common arrhythmia often complicating cardiac imaging due to variable cardiac cycles.
- AF has been a relative contraindication for coronary computed tomography angiography (CCTA) due to image quality concerns.
- Advancements in scanner technology and reconstruction algorithms are improving CCTA feasibility in AF patients.
Purpose of the Study:
- To evaluate the utility of CCTA with an absolute delay reconstruction algorithm in a patient with chronic atrial fibrillation.
- To assess the diagnostic image quality of coronary arteries in a patient requiring CCTA before aortic root dissection repair.
Main Methods:
- Utilized a dual-source scanner with high temporal resolution.
- Employed an absolute delay reconstruction algorithm to map the systolic phase.
- Performed CCTA on a patient with chronic atrial fibrillation and aortic root dissection.
Main Results:
- Coronary computed tomography angiography (CCTA) achieved diagnostic image quality.
- The absolute delay reconstruction algorithm successfully managed image acquisition despite chronic atrial fibrillation.
- Provided clear visualization of coronary arteries for pre-surgical planning.
Conclusions:
- CCTA using absolute delay reconstruction is a viable imaging modality for patients with chronic atrial fibrillation.
- This technique enables accurate coronary assessment in complex clinical scenarios, such as before aortic repair.
- Advanced reconstruction algorithms overcome limitations previously associated with AF in CCTA.
Abstract:
Atrial fibrillation (AF) is the most common persistent arrhythmia. It is associated with wide range of cardiac clinical conditions. Because of variable duration of cardiac cycle resulting in reduced image quality, AF has been considered relative contraindication for performing coronary computed tomography angiography (CCTA). However, recent reports have suggested that newer dual source scanner with higher temporal resolution can be used in patients with AF (Oncel et al., 2007; Wolak et al., 2008; Rist et al., 2009). Image quality can be maintained if heart rate is lowered to less than 70 beats per minute. However, high heart rate can still be challenging. Mapping systolic phase with the use of absolute delay reconstruction algorithm has been shown to provide better image quality. In this article, we present a case of patient with chronic AF and in whom coronary examination was required before going to repair of aortic root dissection. CCTA, with the use of absolute delay reconstruction algorithm, provided diagnostic image quality of the coronary arteries.
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