Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies

Merchant, Faisal M.; Levy, Mathew; Iravanian, Shahriar; Clermont, Edward C; Kelli, Heval Mohamed; Eisner, Robert L.; El‐Chami, Mikhael F.; León, Angel R.; Delurgio, David B.

doi:10.1007/s10840-016-0106-9

Cited by 10 publications

(11 citation statements)

References 19 publications

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“…Good measurement of pulmonary vein ostium is important before planning catheter ablation and after to monitor eventual stenosis of PV [ 29 ]. The narrowing of PV is also important feature, our observation that commLPV ostium is the flattest and that RIPV ostium is the roundest are consistent with the literature data [ 24 , 28 ].…”

Section: Discussionsupporting

confidence: 92%

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Morphology and morphometry of pulmonary veins and the left atrium in multi-slice computed tomography

Polaczek

Szaro

Barańska³

et al. 2019

Surg Radiol Anat

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Purpose Pulmonary veins are involved in pathogenesis and treatment of atrial fibrillation and structures at risk during thoracic surgeries. There is lack of data regarding pulmonary vein morphology and morphometry in normal population. Methods The study was conducted using 135 chest computed tomography studies with intra-venous iodine contrast injection. The study population contained 86 females and 49 males, mean age was 60. 13 had atrial fibrillation. The studies were analyzed using radiological workstation. Results Mean dimensions of the left atrium: transverse 52 mm, coronal 49 mm, and sagittal 35 mm. The mean volume of the left atrium was 93 cm 3 . The mean volume of the left atrium in patients with atrial fibrillation was 176 cm 3 . The sagittal dimension and the volume of the left atrium were correlated with age, r = 0.43 and r = 0.42, respectively. Surface area of the left inferior pulmonary vein ostium was 136 mm 2 , significantly less than the surface area of other ostia of pulmonary veins. The mean distance between two pulmonary veins was 5.42 mm on the right and 4.02 mm on the left side. 13 types of pulmonary veins outflow patterns were described on the right side and 5 types on the left side. 66.7% of right pulmonary veins and 82% of the left pulmonary veins emptied into the left atrium with two venous trunks on each side (the typical pattern). Conclusions Morphological features of pulmonary veins and morphometry of the left atrium and pulmonary veins are important for clinical purposes and are in accordance with previous papers.

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Section: Discussionsupporting

confidence: 92%

“…There is also no agreement on the biggest of PVs. Merchant et al [ 24 ] proved RSPV to be the greatest and also proved the dominance of right PV vs. the left, in Cronin et al [ 6 ] study RIPV was the greatest. On the other hand, Hamdan et al [ 13 ] showed LSPV to be the biggest PV, what is consistent with our findings.…”

Section: Discussionmentioning

confidence: 99%

Morphology and morphometry of pulmonary veins and the left atrium in multi-slice computed tomography

Polaczek

Szaro

Barańska³

et al. 2019

Surg Radiol Anat

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“…For balloon technologies, therefore, PV anatomy would seem to be a potential limitation, compromising the principle "one size fits all" [24]. With the nMARQ TM catheter, otherwise, we were able to manipulate the catheter, which diameter may be changed from 35mm to 20 mm , allowing a better fit to the PV anatomy and shape, without limiting the "one size fits all" principle.…”

Section: Discussionmentioning

confidence: 99%

Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation

Stabile

Anselmino

Soldati

et al. 2016

J Interv Card Electrophysiol

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Results. Mean LA volume was 75±40 ml. A normal anatomy (4 PVs) was documented in 40 (53%) patients, an abnormal anatomy (common truncus or accessory PVs) in 35 patients. Mean procedural and fluoroscopy times were 94 ± 55 minutes and 8 ± 5 minutes, respectively, without significant differences among patients with normal or abnormal anatomy (92±45 min vs 95±64 min, p=0.85 and 6±3 min vs 8±4 min, p=0.65, respectively).Mean ablation time was 14 3 min, 99% of the targeted veins were isolated with a mean of 23±5 RF pulses per patient. After a mean follow-up of 17±8 months, 23(31%) patients had an atrial arrhythmia recurrence. Neither LA volume nor PV anatomy were predictors of outcome.Conclusions. LA volume and PV anatomy did not effect procedural data and outcome in patients who underwent PV isolation by an open-irrigated mapping and RF decapolar ablation catheter.3

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“…PV anatomy was defined using turbospin echo and gradient echo imaging in axial and double oblique planes following administration of gadopentetate dimeglumine (Magnevist ® ) or gadobenate dimeglumine (MultiHance ® ) at a dose of 0.075-0.10 mmol/kg. Orthogonal projections of angiographic images were used to measure PV and LA dimensions[7]. …”

Section: Methodsmentioning

confidence: 99%

Clinical and anatomic predictors of need for repeat atrial fibrillation ablation

Desai

Levy

Iravanian

et al. 2017

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AIMTo identify predictors of need for repeat procedures after initial atrial fibrillation (AF) ablation.METHODSWe identified a cohort undergoing first time AF ablation at our institution from January 2004 to February 2014 who had cardiac magnetic resonance (CMR) imaging performed prior to ablation. Clinical variables and anatomic characteristics (determined from CMR) were assessed as predictors of need for repeat ablation. The decision regarding need for and timing of repeat ablation was at the discretion of the treating physician.RESULTSFrom a cohort of 331 patients, 142 patients (43%) underwent repeat ablation at a mean of 13.6 ± 18.4 mo after the index procedure. Both male gender (81% vs 71%, P = 0.05) and lower ejection fraction (57.4% ± 10.3% vs 59.8% ± 9.4%, P = 0.04) were associated with need for repeat ablation. On pre-ablation CMR, mean pulmonary vein (PV) diameters were significantly larger in all four PVs among patients requiring repeat procedures. In multivariate analysis, increased right superior PV diameter significantly predicted need for repeat ablation (odds ratio 1.08 per millimeter increase in diameter, 95%CI: 1.00-1.16, P = 0.05). There were also trends toward significance for increased left and right inferior PV sizes among those requiring repeat procedures.CONCLUSIONIncreased PV size predicts the need for repeat AF ablation, with each millimeter increase in PV diameter associated with an approximately 5%-10% increased risk of requiring repeat procedures.

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Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies

Cited by 10 publications

References 19 publications

Morphology and morphometry of pulmonary veins and the left atrium in multi-slice computed tomography

Morphology and morphometry of pulmonary veins and the left atrium in multi-slice computed tomography

Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation

Clinical and anatomic predictors of need for repeat atrial fibrillation ablation

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