An anatomical review of the left atrium

Whiteman, Shinelle; Saker, Erfanul; Courant, Vincent; Salandy, Sonja; Gielecki, Jerzy; Żurada, Anna; Loukas, Marios

doi:10.1016/j.tria.2019.100052

Cited by 30 publications

(23 citation statements)

References 33 publications

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“…From the very beginning of the CBA procedure, PNI was associated with right-sided pulmonary vein isolation. No CBA registry in literature without PNI can be found, and every comparison or meta-analysis between RF ablation and cryo-registry shows a disadvantage in this field [6,24,31,37,41,43,49,63,64]. The reason for this issue is a combination of the right phrenic nerve course and cryo-energy dispersion delivered during the procedure [4,65].…”

Section: Discussionmentioning

confidence: 99%

Compound motor action potentials in transient and persistent phrenic nerve injury - metanalysis.

Kuniewicz

Kowalski

Rydlewska

et al. 2021

Preprint

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Background: The right phrenic nerve is vulnerable to injury (rPNI) during cryoballoon ablation (CBA) isolation of the right pulmonary veins. The complication can be transient or persistent. The reported incidence of rPNI fluctuates from 4.73% to 24.7% depending on changes over time, CBA-generation, and selected protective methods. Methods: Through September 2019, a database search was performed on MEDLINE, EMBASE, and Cochrane Database. In the selected articles, the references were also extensively searched. The study provides a comprehensive meta-analysis of the overall prevalence of rPNI, assesses the transient to persistent PNI-ratio, the outcome of using compound motor action potentials (CMAP), and estimated average time to nerve recovery. Results: From 2008 to 2019, 10,341 records from 48 trials were included. Out of 783 eighty- PNI (7.7%), 589 (5.7%) were transient, and 194 (1.9%) were persistent. CMAP caused a significant reduction in the risk of persistent PNI from 2.3% to 1.1% (p = 0.05; odds ratio [OR] 2.13) in all CBA groups. The mean time to rPNI recovery extended beyond the hospital discharge was significantly shorter in CMAP group at three months on average versus non CMAP at six months (p = 0.012). CMAP (in contrast to non-CMAP procedures) detects PNI earlier from 4 to 16 sec (p < 0.05; I2 = 74.53%) and 3 to 9º (p < 0.05; I2 = 97.24%) earlier. Conclusions: rPNI extending beyond hospitalization is a relatively rare complication. CMAP use causes a significant decrease in the risk of prolonged injury and shortens the time to recovery

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Section: Discussionmentioning

confidence: 99%

Compound motor action potentials in transient and persistent phrenic nerve injury - metanalysis.

Kuniewicz

Kowalski

Rydlewska

et al. 2021

Preprint

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“…The anatomy of the LAA is well revised [12][13][14]. Internal structures lined by the pectinate muscle bundles in the LAA do not ramify like the teeth of a comb.…”

Section: Discussionmentioning

confidence: 99%

Applicability of computed tomography preoperative assessment of the LAA in LV summit ablations

Kuniewicz

Krupiński

Gosnell

et al. 2020

J Interv Card Electrophysiol

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Purpose Ventricular arrhythmias originating from the left ventricular summit (LVS) may present with challenges for catheter ablation. Recently, the left atrial appendage (LAA) became a new vantage point for mapping and ablating arrhythmias from that region, but data of possible usefulness is limited. Methods From September to December 2019, we retrospectively analyzed 48 consecutive patient hearts (20 male; mean age 57.9y ± 11.56) undergoing diagnostic coronary vessel imaging in 64 dual-source computer tomography angiography (CTA). Distances from the LAA to the LVS, LAA shape type, and coronary arteries in the LVS region were measured. Also, we compared the true LVS area from CTA with a calculated formula derived from LVS definition. Results The mean LVS area calculated from the formula was 291.58 mm 2 (± 115.5) while the true area calculated from CT was 263.33 mm 2 (± 99.49) (p = 0.44). The mean inaccessible area was 133.42 mm 2 (± 72.89), accessible 95.67 mm 2 (± 72.77). The mean LAA coverage over LVS was 196.08 mm 2-which is approximately 75% of LVS size in general. The most common LAA shape was chicken wing (50%); windsock has the highest accessible area coverage on average (80.23%), followed by chicken wing (59.88%), broccoli (47.72%), and cactus (46.98%). The mean distance from LAA to the surface was 5.14 mm (1.5 to 10 mm) and was not correlated with BMI. LAA has a 98% coverage over the point of transition between the great cardiac vein and anterior interventricular vein. Conclusion Angio-CT assessment of the LAA over the LVS structures may be helpful in decision making before an ablation procedure. LAA appears to be a promising mapping approach in LVS arrhythmias.

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“…Several spatial relationships between the great cardiac vein and the left circumflex coronary artery may be found, with the vein located over the artery being the most common [19]. The left phrenic nerve trespassing epicardially over the left atrial appendage and then directing to the left dome of the diaphragm may cross the mitral margin [27][28][29][30].…”

Section: Mitral Margin Of Lvsmentioning

confidence: 99%

Left Ventricular Summit—Concept, Anatomical Structure and Clinical Significance

et al. 2021

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The left ventricular summit (LVS) is a triangular area located at the most superior portion of the left epicardial ventricular region, surrounded by the two branches of the left coronary artery: the left anterior interventricular artery and the left circumflex artery. The triangle is bounded by the apex, septal and mitral margins and base. This review aims to provide a systematic and comprehensive anatomical description and proper terminology in the LVS region that may facilitate exchanging information among anatomists and electrophysiologists, increasing knowledge of this cardiac region. We postulate that the most dominant septal perforator (not the first septal perforator) should characterize the LVS definition. Abundant epicardial adipose tissue overlying the LVS myocardium may affect arrhythmogenic processes and electrophysiological procedures within the LVS region. The LVS is divided into two clinically significant regions: accessible and inaccessible areas. Rich arterial and venous coronary vasculature and a relatively dense network of cardiac autonomic nerve fibers are present within the LVS boundaries. Although the approach to the LVS may be challenging, it can be executed indirectly using the surrounding structures. Delivery of the proper radiofrequency energy to the arrhythmia source, avoiding coronary artery damage at the same time, may be a challenge. Therefore, coronary angiography or cardiac computed tomography imaging is strongly recommended before any procedure within the LVS region. Further research on LVS morphology and physiology should increase the safety and effectiveness of invasive electrophysiological procedures performed within this region of the human heart.

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An anatomical review of the left atrium

Cited by 30 publications

References 33 publications

Compound motor action potentials in transient and persistent phrenic nerve injury - metanalysis.

Compound motor action potentials in transient and persistent phrenic nerve injury - metanalysis.

Applicability of computed tomography preoperative assessment of the LAA in LV summit ablations

Left Ventricular Summit—Concept, Anatomical Structure and Clinical Significance

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