Anatomical Basis for the Cardiac Interventional Electrophysiologist

Abstract

The establishment of radiofrequency catheter ablation techniques as the mainstay in the treatment of tachycardia has renewed new interest in cardiac anatomy. The interventional arrhythmologist has drawn attention not only to the gross anatomic details of the heart but also to architectural and histological characteristics of various cardiac regions that are relevant to the development or recurrence of tachyarrhythmias and procedural related complications of catheter ablation. In this review, therefore, we discuss some anatomic landmarks commonly used in catheter ablations including the terminal crest, sinus node region, Koch's triangle, cavotricuspid isthmus, Eustachian ridge and valve, pulmonary venous orifices, venoatrial junctions, and ventricular outflow tracts. We also discuss the anatomical features of important structures in the vicinity of the atria and pulmonary veins, such as the esophagus and phrenic nerves. This paper provides basic anatomic information to improve understanding of the mapping and ablative procedures for cardiac interventional electrophysiologists.

Anatomical relevance of ablation to the pulmonary artery root: Clinical implications for characterizing the pulmonary sinus of Valsalva and coronary artery

“…7 Catheter ablation at and around the junction between the RVOT and PT is being increasingly utilized. These extensions could justify the existence of idiopathic supravalvular VAs.…”

“…17,18 More subtle arterial injury may be more common and may present much later after ablation. 7,8 Therefore, the close relationship of LCA to pulmonary root is important for ablation of VAs 3-5 that arise from the myocardium above the hemodynamic junction. 16 The close relationship of the LCA to the PSV was previously highlighted by the potential for LMCA/LAD compression during percutaneous pulmonary valve implantation 19 potential ablation target site for VA, but these features have yet to be fully elucidated.…”

“…17 Other cases of LMCA damage were ascribed to LMCA ostial trauma during catheter passage across the aortic valve. 7,20 This knowledge of related structures is required not only to maximize ablation success but also to decrease the risk of potentially life-threatening collateral damage to the coronary arteries. 7,8 Therefore, the close relationship of LCA to pulmonary root is important for ablation of VAs 3-5 that arise from the myocardium above the hemodynamic junction.…”

“…[1][2][3][4] More recently, the pulmonary sinus of Valsalva (PSV) was proposed to be the potential origin in most right ventricular outflow (RVOT) arrhythmias. 7,8 The complex anatomic relationship between the RVOT and PSV has indicated that VAs likely arise from the myocardial crescents incorporated within the bases of each pulmonary sinus, or the extensions on the epicardial aspect of the sinuses. 7,8 The complex anatomic relationship between the RVOT and PSV has indicated that VAs likely arise from the myocardial crescents incorporated within the bases of each pulmonary sinus, or the extensions on the epicardial aspect of the sinuses.…”

“…There recently reported the successful ablation in the pulmonary artery and PSV and arise the attention to the common extensions of ventricular myocardium in the pulmonary root as well as its relationship to the LCA 12,15. Myocardial extensions above the anatomic junction are the remnants of the turret and may extend to the STJ, or even distal to it 7. The hemodynamic ventriculoarterial junction is produced by these semilunar hinges and bounded by the fibrous interleaflet triangles.…”