Pulmonary Vein Morphology Before and After Segmental Isolation in Patients with Atrial Fibrillation

Ueda, Marehiko; Tada, Hiroshi; Kurosaki, Kenji; Itoi, Kazuhiro; Koyama, Keiko; Naito, Shigeto; Ito, Sachiko; Komuro, Issei; Taniguchi, Koichi

doi:10.1111/j.1540-8159.2005.00214.x

Cited by 11 publications

(11 citation statements)

References 19 publications

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“…First, the number of patients is relatively small and the current approach will need to be repeated on a larger dataset. Second, the results of this study could be confounded by longitudinal shrinkage along the length of the pulmonary vein, as observed in a prior study [5]. If this shrinkage is substantial, it is possible that different anatomical points along the pulmonary vein may be compared at the two timepoints.…”

Section: Discussionmentioning

confidence: 95%

“…This is similar in concept to the centerline approach, however, it can only be used for the portion of the vein that lies in the transverse plane. Another study [5] used curved multi-planar reconstruction images to create an image along the pulmonary vein to measure diameters near ablation lesions. An advantage of a three-dimensional centerline is that it can be used to track and make measurements along the entire vein as it moves in and out of image planes throughout the volume.…”

Section: Discussionmentioning

confidence: 99%

“…Previous work has demonstrated decreases in pulmonary vein ostial size following cardiac ablation therapy [5, 6, 9, 7, 8, 20], however, the full extent of reverse remodeling along the length of the pulmonary veins has not yet been fully characterized. In the current work, differences in cross-sectional area at the two timepoints were observed at all pulmonary vein ostia with this trend holding for up to 3.0 cm into the vein.…”

Section: Discussionmentioning

confidence: 99%

“…In catheter ablation therapy, a standard treatment strategy, catheters are guided into the left atrium and radio frequency energy is delivered circumferentially to each of the pulmonary veins to create an electrical block to the left atrium. Structural remodeling occurs in conjunction with this disease, with atrial fibrillation patients having larger left atria [2, 3, 4, 5] and pulmonary veins [3, 4, 5, 6] than normal controls. Following ablation therapy, these structural changes are reversible, a process termed reverse remodeling, with left atrial size [7, 8, 9, 10, 11] and pulmonary vein diameters [5, 6, 7, 8, 9] significantly decreasing in patients who have returned to normal sinus rhythm.…”

Section: Rationale and Objectivesmentioning

confidence: 99%

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Centerline Tracking for Quantification of Reverse Structural Remodeling of the Pulmonary Veins Following Cardiac Ablation Therapy

et al. 2012

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Rationale and Objectives Patients with atrial fibrillation undergo structural remodeling resulting in increased pulmonary vein sizes. Studies have demonstrated that these changes are reversible following successful ablation therapy. To date, analyses of pulmonary vein structure have focussed on measurements at the pulmonary vein ostia and the full extent of reverse remodeling along the length of the pulmonary veins has not yet been fully characterized. Materials and Methods An automated, three-dimensional method is proposed which quantifies pulmonary vein geometry starting at the ostia and extending several centimeters into the veins. A centerline is tracked along the length of the pulmonary vein and orthogonal planes are computed along the curve. The method is validated against manual measurements on each of the four pulmonary veins for 10 subjects. The proposed methodology is used to analyze the pulmonary veins in 21 patients undergoing cardiac ablation therapy with pre- and post-operative CT scans. Results Validation results demonstrate that the automated measurements closely follow the manual measurements with an overall mean difference of 11.50 mm2. Significant differences in cross-sectional area at the two time-points were observed at all pulmonary vein ostia and extending for 1.5 cm (excluding the 1.0 cm interval) into the left inferior pulmonary vein, 3.0 cm into the left superior pulmonary vein, and 0.5 cm into the right superior pulmonary vein. Conclusions Quantitative analysis along the length of the pulmonary veins can be accomplished using centerline tracking and measurements from orthogonal planes along the curve. The patient study demonstrates that reverse structural remodeling following ablation therapy occurs not only at the ostia, but for several centimeters extending into the pulmonary veins.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Rationale and Objectivesmentioning

confidence: 99%

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Centerline Tracking for Quantification of Reverse Structural Remodeling of the Pulmonary Veins Following Cardiac Ablation Therapy

et al. 2012

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“…For this reason, the pulmonary veins have become the focus of many studies with an emphasis on quantifying their size, structure, and variability. 2–4 Of particular interest is whether pulmonary vein structure is either correlated with disease or could be used in determining treatment strategy. For example, it has been shown that patients with atrial fibrillation are more likely to have variations in their pulmonary vein anatomy as compared with normal controls.…”

Section: Introductionmentioning

confidence: 99%

Toward standardized mapping for left atrial analysis and cardiac ablation guidance

et al. 2014

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In catheter-based cardiac ablation, the pulmonary vein ostia are important landmarks for guiding the ablation procedure, and for this reason, have been the focus of many studies quantifying their size, structure, and variability. Analysis of pulmonary vein structure, however, has been limited by the lack of a standardized reference space for population based studies. Standardized maps are important tools for characterizing anatomic variability across subjects with the goal of separating normal inter-subject variability from abnormal variability associated with disease. In this work, we describe a novel technique for computing flat maps of left atrial anatomy in a standardized space. A flat map of left atrial anatomy is created by casting a single ray through the volume and systematically rotating the camera viewpoint to obtain the entire field of view. The technique is validated by assessing preservation of relative surface areas and distances between the original 3D geometry and the flat map geometry. The proposed methodology is demonstrated on 10 subjects which are subsequently combined to form a probabilistic map of anatomic location for each of the pulmonary vein ostia and the boundary of the left atrial appendage. The probabilistic map demonstrates that the location of the inferior ostia have higher variability than the superior ostia and the variability of the left atrial appendage is similar to the superior pulmonary veins. This technique could also have potential application in mapping electrophysiology data, radio-frequency ablation burns, or treatment planning in cardiac ablation therapy.

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Variations in human pulmonary vein ostia morphology: A systematic review with meta‐analysis

et al. 2022

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This study aimed to establish the most accurate and up‐to‐date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta‐analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left‐sided PVs have smaller ostia than the corresponding right‐sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta‐analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.

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Pulmonary Vein Morphology Before and After Segmental Isolation in Patients with Atrial Fibrillation

Cited by 11 publications

References 19 publications

Centerline Tracking for Quantification of Reverse Structural Remodeling of the Pulmonary Veins Following Cardiac Ablation Therapy

Centerline Tracking for Quantification of Reverse Structural Remodeling of the Pulmonary Veins Following Cardiac Ablation Therapy

Toward standardized mapping for left atrial analysis and cardiac ablation guidance

Variations in human pulmonary vein ostia morphology: A systematic review with meta‐analysis

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