The prevalence of extracardiac findings by multidetector computed tomography before atrial fibrillation ablation

Abstract

The study was designed to determine the prevalence of extracardiac findings discovered during multidetector computed tomography (CT) (MDCT) examinations before atrial fibrillation ablation. Multidetector CT has become a valuable tool in detailing left atrial anatomy before catheter ablation. The incidence of extracardiac findings has been reported for electron beam CT calcium scoring and coronary MDCT, but no data exist for the prevalence of extracardiac findings discovered before atrial fibrillation ablation with MDCT. Clinical reports from MDCT examinations before atrial fibrillation ablation and interpretations by 2 radiologists blinded to the clinical reports were reviewed for significant additional extracardiac findings and recommendations for follow-up. In 149 patients who underwent MDCT, the mean age was 55.9 +/- 11.0 years, 75% were men, and 47% had a history of smoking. Extracardiac findings were identified in 69% of patients with clinical, 90% of reader 1, and 97% of reader 2 interpretations (kappa = 0.086). Follow-up was recommended in 30% of clinical, 50% of reader 1, and 38% of reader 2 interpretations (kappa = 0.408). Pulmonary nodules were the most common additional finding and reason for suggested follow-up for all interpreters. The prevalence of extracardiac abnormalities detected by MDCT is considerable. Significant variability in their identification exists between interpreters, but there is good agreement about the need for further follow-up. It is important that those who interpret these examinations are adequately trained in the identification and interpretation of both cardiac and extracardiac findings.