CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation

Thorning, Chandani; Hamady, Mohamad; Liaw, J.; Juli, Christoph; Lim, Phang Boon; Dhawan, Ranju T.; Peters, Nicholas S.; Davies, D. Wyn; Kanagaratnam, Prapa; O’Neill, Mark; Wright, Andrew

doi:10.1016/j.clinimag.2009.11.005

Cited by 44 publications

(36 citation statements)

References 18 publications

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“…The results support previous ideas that PV anatomy is commonly variable (8,11,(16)(17)(18)(19)(20). The right side tends to be complex, often having one or more accessory veins, whereas the left side tends to be simplified, often having common veins, which rarely occur on the right.…”

Section: Discussionsupporting

confidence: 89%

Evaluation of pulmonary vein anatomy using 256-slice computed tomography

Shi¹,

Mi²,

Shi³

et al. 2017

Turk J Med Sci

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Background/aim: This study aimed to evaluate pulmonary vein (PV) anatomy using 256-slice computed tomography (CT), which may be necessary for electrophysiologists to know before radiofrequency catheter ablation (RFCA) therapy. Materials and methods:A total of 102 patients with paroxysmal and persistent atrial fibrillation underwent 256-slice cardiac CT angiography prior to catheter ablation. PV morphology, ostial diameter, ostial orientation, and distance from ostium to first bifurcation were evaluated using three-dimensional volume-rendering and multiplanar-reformatting technology. Results:We found that 72.5% of patients had four conventional PVs. On the right, 22.5% of patients had one accessory PV, 4.9% had 2 accessory PVs, 1% had one common PV, and 1% had one top vein. On the left, 27.5% of patients had one common PV. Additionally, 9.8% of patients had bilateral PV variation. Ostial size was larger for superior PVs than inferior PVs and larger for right PVs than left PVs. PV ostia on the right tended to be more circular. There was a rather wide variation of projective angle and distance from ostium to first bifurcation. Early branching occurred more often in the right inferior PV. Conclusion:256-Slice CT can depict PV anatomy and afford substantial data, which will help electrophysiologists conduct the RFCA procedure safely and efficiently.

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Section: Discussionsupporting

confidence: 89%

Evaluation of pulmonary vein anatomy using 256-slice computed tomography

Shi¹,

Mi²,

Shi³

et al. 2017

Turk J Med Sci

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“…Improvements in imaging techniques over the past decade have revealed considerably more variations in the number of venous orifices and their arrangements. 11,12 Sleeves of muscle extend from the left atrium to surround the outer aspects of the venous walls for markedly varying lengths toward the lung hilum ( Figure 3A and 3B). 13,14 These sleeves are well illustrated in the publication by Keith and Flack (1907) that documented their discovery of the sinus node.…”

Section: Pulmonary Veinsmentioning

confidence: 99%

Left Atrial Anatomy Revisited

Cabrera²,

Sánchez‐Quintana³

2012

Circ: Arrhythmia and Electrophysiology

305

249

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R ecent decades have seen rapid developments in arrhythmia treatment, especially the use of catheter ablation. Although the substrates of atrial fibrillation, its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium has become a therapeutic option for patients with this arrhythmia. With ablation techniques, various isolation lines and focal targets are deployed; the majority of these are anatomic approaches. It has been over a decade since we published our first article on the anatomy of the left atrium relevant to interventional electrophysiologists. 1 Our aim then, as now, was to increase awareness of anatomic structures inside the left atrium. In this review of anatomy, we revisit the left atrium, inside as well as outside, for a better understanding of the atrial component parts and the spatial relationships of specific structures. Location and Atrial WallsViewed from the frontal aspect of the chest, the left atrium is the most posteriorly situated of the cardiac chambers. Owing to the obliquity of the plane of the atrial septum and the different levels of the orifices of the mitral and tricuspid valves, the left atrial chamber is more posteriorly and superiorly situated relative to the right atrial chamber. The pulmonary veins enter the posterior part of the left atrium with the left veins located more superior than the right veins. The transverse pericardial sinus lies anterior to the left atrium, and in front of the sinus is the root of the aorta. The tracheal bifurcation, the esophagus, and descending thoracic aorta are immediately behind the pericardium overlying the posterior wall of the left atrium. Further behind is the vertebral column.Following the direction of blood flow, the atrial chamber begins at the pulmonary veno-atrial junctions and terminates at the fibro-fatty tissue plane that marks the atrioventricular junction at the mitral orifice. The walls of the left atrium are muscular and can be described as superior, posterior, left lateral, septal (or medial), and anterior, as suggested by McAlpine, 2 who drew attention to the importance of describing the heart in its anatomic position in the chest, in the orientation he termed "attitudinal," which is the appropriate terminology for cardiac interventionists. 3 The left atrium is relatively smooth-walled on its internal aspect ( Figure 1A), but its walls are not uniform in thickness. The roof or superior wall is in close proximity to the bifurcation of the pulmonary trunk and the right pulmonary artery. The thickness of its muscle component measured transmurally ranges from 3.5 to 6.5 mm (mean, 4.5Ϯ0.6 mm) in formalin-fixed heart specimens. 4 The thickness of the lateral wall ranges between 2.5 and 4.9 mm (mean, 3.9Ϯ0.7 mm). The anterior wall, related to the aortic root, ranges from 1.5 to 4.8 mm (mean, 3.3Ϯ1.2 mm) thick, but it can become very thin at the area near the vestibule ( Figure 1B) of the mitral annulus, diminishing to an average thickness of 2 mm. Importantly, there is an area of the anterio...

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“…A CT scan of the left atrium with a standard 64-slice CT using a retrospective gated protocol has an effective dose of almost 14 mSv [16]. According to our unpublished data, an ungated protocol with the same CT has an effective dose of approximately 10 mSv.…”

Section: Catheter Ablation With the Support Of 3dra Of The Left Atriummentioning

confidence: 88%

Periprocedural 3D imaging of the left atrium and esophagus: comparison of different protocols of 3D rotational angiography of the left atrium and esophagus in group of 547 consecutive patients undergoing catheter ablation of the complex atrial arrhythmias

Stárek

Lehar

Jež

et al. 2016

Int J Cardiovasc Imaging

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A new method in creating 3D models of the left atrium (LA) and esophagus before catheter ablation of atrial arrhythmias is 3D rotational angiography (3DRA) of the LA. The purpose of this retrospective study was to test various acquisition protocols of the 3DRA and attempt to define the parameters influencing the success of the protocols. From August 2010 to November 2014, 3DRA of the LA using the Philips Allura FD 10 X-ray system was performed in 547 consecutive patients using right atrial and left atrial protocols. Visualization of the esophagus was performed after oral administration of a contrast agent. Patients were monitored for success (creation of a useful 3D models) and evaluated for a number of parameters affecting the success of 3DRA. The success of the RA protocol was 88.89 % with and 91.91 % without esophagus imaging. The success of the LA protocol was 97.42 % with and 94.54 % without esophagus imaging. The only factor reducing the success of the RA protocol was BMI; the LA protocol was not influenced by any factor. Ventricular fibrillation induced in two patients was successfully treated with defibrillation. 3DRA of the LA is a reliable method that supports catheter ablation of complex atrial arrhythmias. The LA protocol with esophagus imaging was significantly more reliable than the RA protocol; the other protocols were comparable. The RA protocol may be negatively affected by high BMI. Simultaneous imaging of the esophagus is safe and feasible, and the LA protocol can be recommended.

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CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation

Cited by 44 publications

References 18 publications

Evaluation of pulmonary vein anatomy using 256-slice computed tomography

Evaluation of pulmonary vein anatomy using 256-slice computed tomography

Left Atrial Anatomy Revisited

Periprocedural 3D imaging of the left atrium and esophagus: comparison of different protocols of 3D rotational angiography of the left atrium and esophagus in group of 547 consecutive patients undergoing catheter ablation of the complex atrial arrhythmias

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