Comparison of non-gated vs. electrocardiogram-gated 64-detector-row computed tomography for integrated electroanatomic mapping in patients undergoing pulmonary vein isolation

Aims To compare non-gated vs. electrocardiogram (ECG)-gated 64-detector-row computed tomography (MDCT) of the left atrium (LA) for integrated electroanatomic mapping (EAM) in patients with paroxysmal atrial fibrillation (AF). Methods and results Twenty-nine consecutive patients with paroxysmal AF underwent MDCT prior to pulmonary vein isolation (PVI). All patients were in sinus rhythm both during CT imaging and PVI. Multi-detector-row computed tomography was performed in 15 patients without ECG-gating (non-gated MDCT) and in 14 patients with retrospective ECG-gating (ECG-gated MDCT). Image quality of LA reconstructions from MDCT was rated on a five-point scale (from 1 = excellent to 5 = segmentation failed). Registration error between LA geometry obtained from EAM and MDCT was calculated as the mean distance between EAM points and MDCT surface. In all patients, LA was successfully segmented from MDCT data. The segmentation process took 2:31 ± 0:54 min for non-gated MDCT and 2:36 ± 0:47 min for ECG-gated MDCT (P = 0.8). Image quality scores of LA reconstructions from non-gated and ECG-gated MDCT were 1.3 ± 0.6 and 1.4 ± 0.7, respectively (P = 0.76). There was no significant difference in the registration error between non-gated and ECG-gated MDCT (1.8 ± 0.2 vs. 1.9 ± 0.3 mm, respectively; P = 0.6). The radiation dose of non-gated MDCT was significantly lower compared with ECG-gated MDCT (4.6 ± 1.4 vs. 13.4 ± 3.6 mSv, respectively; P < 0.001). Conclusion Non-gated MDCT depicts LA with appropriate image quality for integrated EAM, while exposing patients to substantially lower radiation dose compared with ECG-gated MDCT.