Incidental Cardiac Computed Tomography Findings in Catheter Ablation for AF Planning

Cardiac computed tomography (CCT) is a central tool in the planning of catheter ablation procedures for atrial fibrillation (AF) management. In a study published in Cureus, researchers assessed incidental findings from CCT in patients with AF undergoing catheter ablation.

According to the lead author, Mohamed Hamed, “the use of CCT prior to AF catheter ablation can show multiple incidental findings that can be used as a screening method for the detection of significant conditions in the heart, lungs, and upper abdomen.”

This retrospective study reviewed 218 patients with AF that were undergoing CCT prior to catheter ablation between July 2013 to June 2016. CCT findings were analyzed and incident findings with clinical importance were documented.

Cardiac Computed Tomography Finds Clinically Significant Incidental Conditions

Overall, the authors found that 52 out of 218 (23.85%) patients had clinically significant incidental findings detected by CCT in the chest and upper abdomen. Notably, coronary artery disease (CAD) which would require further invasive diagnostic testing was detected in 15 (6.88%) patients. Additional findings included:

• incomplete cor triatriatum: 1 (0.45%)
• pulmonary nodules: 18 (8.25%)
• pulmonary infiltrates: 8 (3.66%)
• pulmonary mass: 1 (0.45%)
• pleural effusion: 9 (4.12%)
• thoracic aortic aneurysm: 3 (1.37%)
• mediastinal nodes: 7 (3.21%)
• abdominal mass: 2 (0.91%)
• liver nodules: 4 (1.83%)

The researchers noted the study was limited by a small sample size, the retrospective design and lack of long-term follow-up, and the de-identification of patients, which limited analyses of demographic factors. The authors also wrote that their findings were comparable to similar previous studies with a slightly lower incidence of incidental findings.

In closing, the authors acknowledged it is uncertain whether or not managing these findings is worth the associated costs and risks for the patient—particularly as many findings are benign. Nonetheless, they suggested a “marked benefit” was possible if these findings represented early stages of malignant diseases and ended their report with a call for larger prospective trials to explore that possibility.

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