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A recent cohort study published in JAMA Cardiology has highlighted the potential of contrast-enhanced computed tomography (CECT) in accurately localizing fatty tissue within the heart. The study focused on the fatty tissue insulating the atrioventricular node and the proximal specialized conduction system (AVCS) from surrounding muscle. This capability of CECT could pave the way for improved heart treatment strategies, particularly in planning for interventional, electrophysiologic, and surgical procedures by providing a detailed anatomical roadmap.
The AVCS is composed of muscle cells responsible for transmitting excitatory impulses from the atria to the ventricles, known as the conductive myocardium. Fatty deposits infiltrating this system can predispose patients to heart disease and complications.
Previous studies have indicated that CECT can identify heart structures by localizing myocardial fat with high specificity. Dr. Mirmilad Khoshknab and colleagues from the Hospital of the University of Pennsylvania tested the hypothesis that pre-procedure CECT can accurately localize the AVCS by identifying the insulating fat.
In their prospective cohort study conducted at an academic tertiary care center, the researchers included patients who had undergone CECT less than a month before atrial fibrillation ablation and electroanatomic localization of the His electrogram signal. The study found that among 20 patients, the mean attenuation of the AVCS fat segmentation was 2.9 Hounsfield units, and the mean distance from the His electrogram to the closest AVCS fat voxel was 3.3 mm.
The results suggest that CECT could accurately localize the fatty tissue insulating the AVCS, enhancing the safety and efficacy of procedures targeting the conduction system and its surrounding structures.
Read the full article here.