Anatomical Evaluation of the Pulmonary Veins and the Left Atrium Using Computed Tomography Before Catheter Ablation: Reproducibility of Measurements

Abstract

SummaryBackgroundAtrial fibrillation (AF) is a common supraventricular arrhythmia. ECG-gated MDCT seems to be currently a method of choice for pre-ablation anatomical mapping due to an excellent resolution and truly isotropic three-dimensional nature. The aim of this study was to establish the between-subject variability and inter-observer reproducibility of anatomical evaluation of the pulmonary veins (PV) and the left atrium (LA) using computed tomography.Material/MethodsA retrospective analysis included 42 patients with AF, who were scheduled for a cardiac CT for ablation planning. Images were assessed by two independent radiologists using a semi-automatic software tool. The left atrium anatomy (volume, AP diameter), anatomy of the pulmonary veins (number, ostia diameters and surface area) were evaluated. The relative between-subject variability and the inter-observer variability of measurements were calculated.ResultsThe heart rate during scanning ranged from 50 to 133/min. (mean 79.1/min.) and all examinations were of adequate image quality. Accessory pulmonary veins were found in 24% of patients. Between-subject variability of the PV ostial cross-sectional area ranged from 33% to 48%. The variability of the left atrium size was 21% for the diameter and 35% for the volume. The inter-observer agreement for the detection of accessory pulmonary veins was good (κ=0.73; 95% CI, 0.54–0.93).ConclusionsBetween-subject variability of the pulmonary vein ostial cross-sectional area and the left artial volume is substantial. The anatomical assessment of the pulmonary vein ostia and the left atrium size in computed tomography presents a good inter-observer reproducibility.

Pulmonary vein anatomy variants as a biomarker of atrial fibrillation – CT angiography evaluation

“…Similarly to previous observations [ 2 , 3 , 8 , 19 – 21 ] the data collected confirm larger diameters of LA, superior and inferior PVs in patients with AF. We want this study to underline the complexity of anatomical changes that may trigger AF.…”

High anatomical accuracy of a novel high‐resolution wide‐band dielectric imaging system in cryoballoon‐based ablation

“…In our study, measurements of the ostial PV‐diameters using the novel imaging system correlated with those from angiographic assessment as demonstrated by Passing‐Bablok regression analyses ( Figure ). Furthermore, our results regarding PV‐diameters are comparable to data from previous studies using computed tomography (CT) prior to catheter ablation for the assessment of LA and PV‐anatomy 28,29 and revealed the RIPV as generally the smallest of all four 28 . It should be noted however, that PV‐measurements using imaging methods like CT or MRI are frequently performed in divergent projections and therefore are only comparable to a limited extent.…”

Clinical anatomy of human heart atria and interatrial septum — anatomical basis for interventional cardiologists and electrocardiologists. Part 2: left atrium

“…Pulmonary vein ostia are ellipsoid in shape with longer superior-inferior rather than transverse dimensions. The ostial area of all veins significantly and positively correlates with LA volume [9]. Transverse ostium diameters are around 13-15 mm and are significantly larger for the superior PVs than for the inferior ones.…”