Collateral findings during computed tomography scan for atrial fibrillation ablation: Let’s take a look around

Abstract

The growing number of atrial fibrillation catheter ablation procedures warranted the development of advanced cardiac mapping techniques, such as image integration between electroanatomical map and cardiac computed tomography. While scanning the chest before catheter ablation, it is frequent to detect cardiac and extracardiac collateral findings. Most collateral findings are promptly recognized as benign and do not require further attention. However, sometimes clinically relevant collateral findings are detected, which often warrant extra diagnostic examinations or even invasive procedure, and sometimes need to be followed-up over time. Even though reporting and further investigating collateral findings has not shown a clear survival benefit, almost all the working groups providing data on collateral findings reported some collateral findings eventually coming out to be malignancies, sometimes at an early stage. Therefore, there is currently no clear agreement about the right strategy to be followed.

Keywords: Collateral findings; Incidental findings; Incidentalomas; Cardiac computed tomography; Image integration

Core tip: Several cardiac computed tomography (CT) scans are performed worldwide in order to better delineate left atrial anatomy before atrial fibrillation (AF) ablation. A thorough examination of the entire field of view often discovers cardiac or extra-cardiac collateral findings, which might represent potentially malignant diseases. Early detection of such diseases may guarantee a curative treatment. Our objective is to consolidate the current literature about collateral findings detected at cardiac CT before AF ablation and to highlight the potential implications of systematically reporting and following up such findings.