Abstract
Imaging guidance provided by optical coherence tomography (OCT) could improve the outcomes of atrial fibrillation (AF) ablation by providing detailed structural information of the pulmonary veins, which are critical targets during ablation. In this study, stitched volumetric OCT images of venoatrial junctions from post-mortem human hearts were acquired and compared to histology. Image features corresponding to venous media and myocardial sleeves, as well as fiber orientation and fibrosis, were identified and found to vary between veins. Imaging of detailed tissue architecture could improve understanding of the AF structural substrate within the pulmonary veins and assist the guidance of ablation procedures.
Highlights
Understanding the myocardial structure of the pulmonary veins (PVs) has become of significant importance since the discovery that atrial fibrillation (AF) can be initiated by ectopic beats originating within the PV myocardial sleeves [1]
The intricate structure of the PVs have been linked to AF dynamics, with studies in canines showing regions of myofiber complexity correlated to electrical conduction disturbances [5,6], while arrhythmogenic high-frequency potentials have been associated with thickened PV walls [7]
This study demonstrated that optical coherence tomography (OCT) is able to image similar myocardial sleeve features as seen from histology
Summary
Understanding the myocardial structure of the pulmonary veins (PVs) has become of significant importance since the discovery that atrial fibrillation (AF) can be initiated by ectopic beats originating within the PV myocardial sleeves [1]. AF patients have been reported to have higher degrees of discontinuity, hypertrophy, and fibrosis within their PV myocardial sleeves [3]. These studies emphasize the complex and variable PV tissue structure and that these structural features may have a significant influence on AF mechanisms. Detailed imaging of PV tissue structure could improve the understanding of the structural substrate underlying AF as well as provide guidance to improve ablation, which still suffers from variable success [8]. High frequency intravascular ultrasound has been used to image the PVs in vivo and is able to capture the thicknesses of the different layers of the vein wall, as well as the lengths of the myocardial sleeves [7,9]. The ability of ultrasound to resolve finer features such as fibrosis and fiber orientation in detail may be limited
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