TY - JOUR
T1 - Assessment of pulmonary vein anatomic variability by magnetic resonance imaging
T2 - Implications for catheter ablation techniques for atrial fibrillation
AU - Mansour, Moussa
AU - Holmvang, Godtfred
AU - Sosnovik, David
AU - Migrino, Raymond
AU - Abbara, Suhny
AU - Ruskin, Jeremy
AU - Keane, David
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2004/4
Y1 - 2004/4
N2 - Introduction: Pulmonary vein (PV) isolation for atrial fibrillation (AF) currently is performed using either an ostial or an extra-ostial approach. The objective of this study was to analyze by three-dimensional (3D) magnetic resonance angiography (MRA) the anatomy of the PVs in order to detect structural variability that would impact the choice of ablation approach. Methods and Results: Three-dimensional MRA was performed in 105 patients undergoing PV isolation. The ostial diameter, branching pattern, and PV angulation were analyzed. Fifty-nine (56%) patients had the typical pattern of 4 PVs with 4 separate ostia, 30 (29%) patients had an additional PV, and 18 (17%) patients had a left common PV trunk. In two patients, there were three right-sided veins and a common left-sided trunk, giving rise to four ostia: three on the right and one on the left. Two different populations of right middle PVs were noted: one where the additional vein projected anteriorly to drain the right middle lobe and one posterior to drain the superior portion of the right lower lobe. The average intrapatient variability in PV diameter was 7.9 ± 4.2 mm. The PV ostium was <10 mm in 26 (25%) patients and >25 mm in 15 (14%) patients. The first branch originated 6.7 ± 2.3 mm from the ostium. The left superior, right superior, right inferior, and left inferior PVs were found to enter the left atrium at the following angles: 32 ± 13°, 131 ± 11°, 206 ± 16°, and 329 ± 14°, respectively. Forty-nine patients (47%) had at least one funnel shaped PV. Conclusion: This largest PV imaging study to date demonstrates that MRA is a valuable tool that allows detection of marked intrapatient and interpatient anatomic variability of the PVs. These findings suggest that, at least in some patients, circumferential extra-ostial left atrial encirclement of the PVs may be preferable to ostial PV isolation. These findings also may have significant implications on the future development of coil- and balloon-based catheter ablation designs for AF ablation.
AB - Introduction: Pulmonary vein (PV) isolation for atrial fibrillation (AF) currently is performed using either an ostial or an extra-ostial approach. The objective of this study was to analyze by three-dimensional (3D) magnetic resonance angiography (MRA) the anatomy of the PVs in order to detect structural variability that would impact the choice of ablation approach. Methods and Results: Three-dimensional MRA was performed in 105 patients undergoing PV isolation. The ostial diameter, branching pattern, and PV angulation were analyzed. Fifty-nine (56%) patients had the typical pattern of 4 PVs with 4 separate ostia, 30 (29%) patients had an additional PV, and 18 (17%) patients had a left common PV trunk. In two patients, there were three right-sided veins and a common left-sided trunk, giving rise to four ostia: three on the right and one on the left. Two different populations of right middle PVs were noted: one where the additional vein projected anteriorly to drain the right middle lobe and one posterior to drain the superior portion of the right lower lobe. The average intrapatient variability in PV diameter was 7.9 ± 4.2 mm. The PV ostium was <10 mm in 26 (25%) patients and >25 mm in 15 (14%) patients. The first branch originated 6.7 ± 2.3 mm from the ostium. The left superior, right superior, right inferior, and left inferior PVs were found to enter the left atrium at the following angles: 32 ± 13°, 131 ± 11°, 206 ± 16°, and 329 ± 14°, respectively. Forty-nine patients (47%) had at least one funnel shaped PV. Conclusion: This largest PV imaging study to date demonstrates that MRA is a valuable tool that allows detection of marked intrapatient and interpatient anatomic variability of the PVs. These findings suggest that, at least in some patients, circumferential extra-ostial left atrial encirclement of the PVs may be preferable to ostial PV isolation. These findings also may have significant implications on the future development of coil- and balloon-based catheter ablation designs for AF ablation.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Magnetic resonance imaging
KW - Pulmonary vein isolation
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U2 - 10.1046/j.1540-8167.2004.03515.x
DO - 10.1046/j.1540-8167.2004.03515.x
M3 - Article
C2 - 15089984
AN - SCOPUS:1942536466
SN - 1045-3873
VL - 15
SP - 387
EP - 393
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 4
ER -