Pulmonary Vein Anatomy in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Kato, Ryuichi; Lickfett, Lars; Meininger, Glenn; Dickfeld, Timm; Wu, Richard C.; Juang, George; Angkeow, Piamsook; LaCorte, Jennifer; Bluemke, David A.; Berger, Ronald D.; Halperin, Henry R.; Calkins, Hugh

doi:10.1161/01.cir.0000061951.81767.4e

Cited by 433 publications

(108 citation statements)

References 23 publications

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“…The need for such data is underscored by the fact that atrial anatomy varies greatly in the human population as documented by in vivo imaging. 15,16 Diffusion tensor magnetic resonance imaging (DTMRI) is a noninvasive technique that uses water diffusion as a probe to image fiber orientation in tissue. 17,18 DTMRI has been widely used to study fiber architecture in the brain and other organs.…”

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confidence: 99%

Myofiber Architecture of the Human Atria as Revealed by Submillimeter Diffusion Tensor Imaging

Pashakhanloo

Herzka

Ashikaga

et al. 2016

Circ: Arrhythmia and Electrophysiology

156

141

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Background-Accurate knowledge of the human atrial fibrous structure is paramount in understanding the mechanisms of atrial electric function in health and disease. Thus far, such knowledge has been acquired from destructive sectioning, and there is a paucity of data about atrial fiber architecture variability in the human population. Methods and Results-In this study, we have developed a customized 3-dimensional diffusion tensor magnetic resonance imaging sequence on a clinical scanner that makes it possible to image an entire intact human heart specimen ex vivo at submillimeter resolution. The data from 8 human atrial specimens obtained with this technique present complete maps of the fibrous organization of the human atria. The findings demonstrate that the main features of atrial anatomy are mostly preserved across subjects although the exact location and orientation of atrial bundles vary. Using the full tractography data, we were able to cluster, visualize, and characterize the distinct major bundles in the human atria. Furthermore, quantitative characterization of the fiber angles across the atrial wall revealed that the transmural fiber angle distribution is heterogeneous throughout different regions of the atria. Conclusions-The application of submillimeter diffusion tensor magnetic resonance imaging provides an unprecedented level of information on both human atrial structure, as well as its intersubject variability. The high resolution and fidelity of this data could enhance our understanding of structural contributions to atrial rhythm and pump disorders and lead to improvements in their targeted treatment. (Circ Arrhythm Electrophysiol. 2016;9:e004133.

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mentioning

confidence: 99%

Myofiber Architecture of the Human Atria as Revealed by Submillimeter Diffusion Tensor Imaging

Pashakhanloo

Herzka

Ashikaga

et al. 2016

Circ: Arrhythmia and Electrophysiology

156

141

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“…Similar to other authors [9][10][11][12], we accept only a change in PV CSA of more than 20% and we also classify the mild (insignificant) stenoses as a change in the range between The size of the CSA versus the size of a triangle approximation using a long (l=a) and short (s=b) size of PV (A=l×s). Size and definitions of the ellipse and triangle are explained in Fig.…”

Section: Assessment Of Pv Stenosismentioning

confidence: 62%

“…High importance of cross-sectional imaging using either computed tomography (CT) or magnetic resonance (MR) was already shown for ablation planning [6,7]. However, one of the recognised complications associated with RF ablation within or around the PV ostia is PV stenosis [8][9][10][11][12][13][14][15][16]. Therefore, a reliable and non-invasive imaging method is needed to evaluate and quantify potential PV stenoses after the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

et al. 2006

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One of the recognised complications of catheter ablation is pulmonary venous stenosis. The aim of this study was to compare two methods of evaluation of pulmonary venous diameter for follow-up assessment of the above complication: (1) a linear approach evaluating two main diameters of the vein, (2) semiautomatically measured cross-sectional area (CSA). The study population consists of 29 patients. All subjects underwent contrast-enhanced magnetic resonance angiography (CeMRA) of the pulmonary veins (PVs) before and after the ablation; 14 patients were also scanned 3 months later. PV diameter was evaluated from two-dimensional multiplanar reconstructions by measuring either the linear diameter or CSA. A comparison between pulmonary venous CSA and linear measurements revealed a systematic difference in absolute values. This difference was not significant when comparing the relative change CSA and quadratic approximation using linear extents (linear approach). However, a trend towards over-estimation of calibre reduction was documented for the linear approach. Using CSA assessment, significant PV stenosis was found in ten PVs (8%) shortly after ablation. Less significant PV stenosis, ranging from 20 to 50% was documented in other 18 PVs (15%). CeMRA with CSA assessment of the PVs is suitable method for evaluation of PV diameters.

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“…For this reason it is not surprising that in a pilot computed tomography (CT) study, we were unable to visualize the PV or the freezing process within it 8 . So, despite the past successes of clinical image guidance for cryoablation in cm sized tissues [9][10][11] …”

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confidence: 99%

A micro-thermal sensor for focal therapy applications

et al. 2016

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There is an urgent need for sensors deployed during focal therapies to inform treatment planning and in vivo monitoring in thin tissues. Specifically, the measurement of thermal properties, cooling surface contact, tissue thickness, blood flow and phase change with mm to sub mm accuracy are needed. As a proof of principle, we demonstrate that a micro-thermal sensor based on the supported "3ω" technique can achieve this in vitro under idealized conditions in 0.5 to 2 mm thick tissues relevant to cryoablation of the pulmonary vein (PV). To begin with "3ω" sensors were microfabricated onto flat glass as an idealization of a focal probe surface. The sensor was then used to make new measurements of 'k' (W/m.K) of porcine PV, esophagus, and phrenic nerve, all needed for PV cryoabalation treatment planning. Further, by modifying the sensor use from traditional to dynamic mode new measurements related to tissue vs. fluid (i.e. water) contact, fluid flow conditions, tissue thickness, and phase change were made. In summary, the in vitro idealized system data presented is promising and warrants future work to integrate and test supported "3ω" sensors on in vivo deployed focal therapy probe surfaces (i.e. balloons or catheters).Focal energy based therapies have a long history of use in the treatment of cancer, cardiovascular and neural disease [1][2][3] . As the technique evolves, there are increasingly thin and complex tissue anatomies where focal therapies and freezing are being applied that require sub mm monitoring accuracy to avoid debilitating side effects. For instance, cryogenic approaches to treatment of atrial fibrillation are increasingly being used in the pulmonary vein (PV) which is only 1-2 mm thick 4-7 . This treatment in thin PV often suffers from over and under-freezing suggesting a need for better monitoring. Unfortunately, traditional clinical imaging has difficulty monitoring at or below the mm scale, which is of the order of thickness of the PV itself. For this reason it is not surprising that in a pilot computed tomography (CT) study, we were unable to visualize the PV or the freezing process within it 8 . So, despite the past successes of clinical image guidance for cryoablation in cm sized tissues [9][10][11]

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Pulmonary Vein Anatomy in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Cited by 433 publications

References 23 publications

Myofiber Architecture of the Human Atria as Revealed by Submillimeter Diffusion Tensor Imaging

Myofiber Architecture of the Human Atria as Revealed by Submillimeter Diffusion Tensor Imaging

Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

A micro-thermal sensor for focal therapy applications

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