Abstract
BackgroundIt has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation.The aim of the study was to assess anatomy abnormalities of the PV and LA in the patients with the history of AF and compare it with the control group(CG).MethodsThe multi-slice tomography (MSCT) scans were performed in 224 AF pts. before PVI (129 males, mean age 59 ± 9 yrs). The CG consisted of 40 pts. without AF (26 males, age 45 ± 9 yrs). LA and PV anatomy were evaluated. Diameters of PV ostia were measured in two directions: anterior-posterior (AP) and superior-inferior (SI) automatically using Vitrea 4.0.ResultsPulmonary veins anatomy variants were observed more frequently in the atrial fibrillation group - 83 pts. (37%) vs 6 pts. (15%) in CG; 9% (21 pts) left common ostia (CO), 2% (5 pts) right CO, 19% (42 pts) additional right PV (APV), (1.8%) 4 pts. APV left, 8% right early branching (EB) and 3.5% left EB. The LA diameter differed significantly in AF vs CG group (41.2 ± 6 mm vs 35 ± 4.2 mm, p < 0.0001) respectively.ConclusionsThe anomalies of pulmonary vein anatomy occurred more often in pts. with AF. They can be defined as an image biomarkers of atrial fibrillation. Right additional (middle) pulmonary vein was the most important anomaly detected in AF patients as well as enlargered diameters of the LA and PV ostia.
Highlights
It has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients with atrial fibrillation
Incidental findings We found rare anomalies in 7 pts. with AF – they were excluded from the analysis but we find it worth presenting
Several researchers, cardiologists, radiologists and surgeons studied the anatomy of LA and PV because of a variety of endovascular and surgical techniques used for invasive therapy of patients with AF [2,3,4,5,6,7]
Summary
It has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation. Pulmonary vein isolation (PVI) over the last decade has become the most demanded method for AF treatment. A detailed visualization of the left atrium (LA) and pulmonary vein (PV) anatomy can be obtained by several different imaging methods including. Some authors suggest that those anomalies may play a significant role in the pathophysiology of atrial fibrillation and even increase its prevalence [4, 6]. The purpose of this study was to evaluate the occurrence of anatomy anomalies of PV and the left atrium using
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