Assessment of Pulmonary Vein Anatomic Variability by Magnetic Resonance Imaging:

Abstract

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.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…771 A detailed understanding of this anatomy is essential for a safe and effective AF ablation procedure. 772 There is a significant inter- and intrapatient variability in the number, size, and bifurcation of the PVs 67,773, 774,775,776,777,778 (Figure 2). Common variations include supernumerary right PVs (18%–29%) and common trunk (>30%), mainly located on the left side and right middle or right top PV.…”

“…434,505,778,1142,1144,1150,1151 This variation results from differences in the ablation technique, definitions of PV stenosis, the intensity of screening for this complication, and the date the study was performed. When PV ablation for treating AF began in the late 1990s, investigators were unaware that PV stenosis was a potential complication.…”

Cardiac cycle–dependent left atrial dynamics: Implications for catheter ablation of atrial fibrillation

“…Our data reveal that very little motion occurs in the posterior aspect of the pulmonary veins; therefore, the pulmonary vein ostia should be incorporated into future schemes for the registration of left atrial images. It has previously been shown that the diameter of the pulmonary vein ostia changes over the cardiac cycle and that the pulmonary veins enter the LA at a variety of angles (13). It is possible that the significant LAV changes that occur during the cardiac cycle influence the angle at which the pulmonary veins are entering the LA at any given point.…”

“…This 3D display provides a better understanding of the complex LA anatomy than the two dimensional views from fluoroscopy, pulmonary venograms or intra-cardiac echocardiography and offers the potential to improve catheter navigation and increase accuracy of ablation lesion placement (12,13).…”

Prevalence, Morphological and Electrophysiological Characteristics of Confluent Inferior Pulmonary Veins in Patients With Atrial Fibrillation

“…The most common abnormality reported so far is the confluent left PVs, which have been reported to be present in 3-29% of the cases who underwent 3-D imagings. [7][8][9][10][11][12][13][14] In a report by Kato et al, 8 a short common left trunk, in which the junction of the lower wall of the LSPV and upper wall of the LIPV lies outside the LA rim, could be seen in 22% (12 of 55 cases), while a long common left trunk was also present in 7% (4 of 55). In this study, we found that 1.5% of cases who underwent PVI of AF have another type of anomalous PV drainage with a conjunction of contralateral inferior PVs.…”