Abstract
BackgroundThe ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical correlation between left atrium (LA)-pulmonary vein (PV) and adjacent structures.MethodsData were collected from 126 consecutive patients using coronary artery CT angiography. The LA roof was divided into three layers and nine points. The minimal spatial distances from the nine points and four PV orifices to the adjacent bronchi and PAs were measured. The distances from the PV orifices to the nearest contact points of the PVs, bronchi, and PAs were measured.ResultsThe anterior points of the LA roof were farther to the bronchi than the middle or posterior points. The distances from the nine points to the PAs were shorter than those to the bronchi (5.19 ± 3.33 mm vs 8.62 ± 3.07 mm; P < .001). The bilateral superior PV orifices, especially the right superior PV orifices were closer to the PAs than the inferior PV orifices (left superior PV: 7.59 ± 4.14 mm; right superior PV: 4.43 ± 2.51 mm; left inferior PV: 24.74 ± 5.26 mm; right inferior PV: 22.33 ± 4.75 mm) (P < .001).ConclusionsThe right superior PV orifices were closer to the bronchi and PAs than other PV orifices. The ablation at the mid-posterior LA roof had a higher possibility to damage bronchi. CT is a feasible method to assess the anatomical adjacency in vivo, which might provide guidance for AF ablation.
Highlights
The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs)
[9] The clinical trial of sustained treatment of paroxysmal atrial fibrillation (STOP-AF) [11] showed that the incidence of persistent cough caused by cryoablation was 17%, and its subsequent post-approval clinical trial [12] showed that the incidence of hemoptysis caused by ablation was 1%
We used LA1 × LA2 × LA3 to denote the left atrium (LA) size, and the results showed that the LA size of 126 patients was 128,372 ± 40,466 mm3, which was significantly related to the height (r = 0.36, P < .01), and weight (r = 0.41, P < .01)
Summary
The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). Wang et al BMC Cardiovasc Disord (2021) 21:84 cardiac electrophysiologists have paid enough attention to the injury of esophagus and phrenic nerves, and several studies have explored the anatomical correlation between the left atrium (LA)-PV ablation targets of AF and adjacent esophagus and phrenic nerve [3,4,5,6,7]. The ablation targets of AF are adjacent to the lung, airway, and pulmonary artery (PA), such that the ablation energy may damage the bronchi, PAs, and lung parenchyma, resulting in the symptoms of cough, dyspnea, hemoptysis, and even death in the patients [5, 9]. The PV ablation resulted in ice crystal formation and internal hemorrhage in the main bronchus was reported in seven patients [14]
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