Left atrial (LA) volume can be determined during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) with angiography or electro-anatomic (CARTO) mapping. We compared these volumes with LA volume measured using transthoracic real-time three-dimensional echocardiography (3DE). One hundred and twenty-seven consecutive patients undergoing RFCA for AF were studied using biplane pulmonary vein angiography with opacification of the LA. LA volume was calculated from the diameter measurements with a formula using an ellipsoid model. A subset of 22 patients also underwent LA volume determination by CARTO mapping. These volumes were then correlated with LA volume determined non-invasively by real-time 3DE. Linear regression showed a significant correlation between LA volume determined by angiography and 3DE volume ( r = 0.56, P < 0.0001). Bland–Altman analysis showed a bias of 38 ± 22 ml by the angiographic method. LA volume measured using CARTO correlated better ( r = 0.67, P < 0.001), but 3DE yielded smaller values (mean difference of −30 ± 19 ml). LA volume determination by angiography and CARTO mapping correlate significantly with 3DE volume. However, both invasive techniques yield larger values for LA volume. The results indicate that LA volume obtained by angiography or CARTO should not be used as baseline value for non-invasive follow-up of LA remodelling by 3DE.

Cardiac papillary fibroelastoma is a rare, benign cardiac tumor. It often arises from valvular endocardium, and non-valvular endocardial location is rare. Although transthoracic echocardiography is usually sufficient for the diagnosis of most cardiac tumors, small tumors such as papillary fibroelastoma may be missed. Transesophageal echocardiography is superior to transthoracic echocardiography in diagnosing these tumors. Despite their benign histology, and independent of their size, they should be resected surgically because of their high potential for embolization. In this report, we present a case of papillary fibroelastoma located on the left atrial wall, presenting with symptoms of cerebral ischemia. The patient was treated surgically for the prevention of further embolic complications. Pertinent literature is also reviewed for this rare and benign cardiac tumor.