Abstract 2544: Pulmonary Venous Anatomy Predicts Recurrent Arrhythmia after Pulmonary Vein Antrum Isolation for Atrial Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ron Jacob ◽  
Dimpi Patel ◽  
Michael Lieber ◽  
Michelle Williams ◽  
Andrea Natale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Complex Anatomy ◽  
Recurrent Atrial Fibrillation ◽  
Increased Risk ◽  
Left Pulmonary Vein ◽  
Pulmonary Vein Anatomy ◽  
Pulmonary Vein Antrum Isolation

Background: Pulmonary Vein Antrum Isolation (PVAI) is being used with increasing frequency for the treatment of atrial fibrillation. Multi-detector computed tomography (MDCT) can be used to evaluate the complex anatomy of the left atrium and pulmonary veins to facilitate PVAI. We hypothesized that pulmonary vein anatomy, as determined by MDCT, would predict recurrent atrial fibrillation after PVAI. Methods: We evaluated consecutive patients scheduled for PVAI who underwent a CT examination of the pulmonary veins on a Philips Brilliance 64 or Siemens Sensation-64 slice MDCT scanner < 3 months prior to a PVAI procedure. The number and ostial area of all pulmonary veins, indexed to body surface area, were determined by 2 independent blinded observers. Transtelephonic monitoring was performed for the first 3– 6 months after the PVAI procedure. Patients were followed at 3, 6, and 12 months with a 12-lead EKG and 48-hour Holter monitor. Results: A total of 113 patients (mean age 58±10 years; 73% male) were enrolled and followed for 12 months. A total of 445 pulmonary vein ostia were analyzed; 26% of patients had left sided pulmonary veins with a shared common ostium. The remaining patients had 2 separate left sided pulmonary veins. At the end of the 12-month follow-up, patients with two left sided pulmonary veins had a significantly increased risk of recurrent arrhythmia (34.3%) after PVAI than patients with a common left pulmonary vein (7.7%; p=0.009; OR 4.45). There was no relationship between the number of right sided pulmonary veins or total pulmonary vein ostial size and recurrent arrhythmia (582 cm 2 /m 2 in patients with recurrence vs 505 cm 2 /m 2 without recurrence (P= 0.14). Conclusion: In patients undergoing PVAI for atrial fibrillation, the presence of two left sided pulmonary veins, as determined by MDCT, is associated with an increased risk of recurrent arrhythmia at 12 months compared with patients who have a single common left pulmonary vein.

scholarly journals Normal distal pulmonary vein anatomy

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1579 ◽  
Author(s):  
Wiesława Klimek-Piotrowska ◽  
Mateusz K. Hołda ◽  
Katarzyna Piątek ◽  
Mateusz Koziej ◽  
Jakub Hołda
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Interventional Procedures ◽  
Critical Role ◽  
Pulmonary Veins ◽  
Safety And Efficacy ◽  
Classical Pattern ◽  
The Common ◽  
The Mean ◽  
Pulmonary Vein Anatomy

Background.It is well known that the pulmonary veins (PVs), especially their myocardial sleeves play a critical role in the initiation and maintenance of atrial fibrillation. Understanding the PV anatomy is crucial for the safety and efficacy of all procedures performed on PVs. The aim of this study was to present normal distal PV anatomy and to create a juxtaposition of all PV ostium variants.Methods.A total of 130 randomly selected autopsied adult human hearts (Caucasian) were examined. The number of PVs ostia was evaluated and their diameter was measured. The ostium-to-last-tributary distance and macroscopic presence of myocardial sleeves were also evaluated.Results.Five hundred forty-one PV ostia were identified. Four classical PV ostia patterns (two left and two right PVs) were observed in 70.8% of all cases. The most common variant was the classical pattern with additional middle right PV (19.2%), followed by the common ostium for the left superior and the inferior PVs (4.44%). Mean diameters of PV ostia (for the classical pattern) were: left superior = 13.8 ± 2.9 mm; left inferior = 13.3 ± 3.4 mm; right superior = 14.3 ± 2.9 mm; right inferior = 13.7 ± 3.3 mm. When present, the additional middle right PV ostium had the smallest PV ostium diameter in the heart (8.2 ± 4.1 mm). The mean ostium-to-last-tributary (closest to the atrium) distances were: left superior = 15.1 ± 4.6 mm; left inferior = 13.5 ± 4.0 mm; right superior = 11.8 ± 4.0 mm; right inferior = 11.0 ± 3.7 mm. There were no statistically significant differences between sexes in ostia diameters and ostium-to-last-tributary distances.Conclusion.Only 71% of the cases have four standard pulmonary veins. The middle right pulmonary vein is present in almost 20% of patients. Presented data can provide useful information for the clinicians during interventional procedures or radiologic examinations of PVs.

Initial Experience with Robotic Epicardial Off-Pump Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

2006 ◽  
Vol 1 (5) ◽  
pp. 247-250
Author(s):  
Filip Casselman ◽  
Ihsan Bakir ◽  
Pedro Brugada ◽  
Peter Geelen ◽  
Francis Wellens ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Median Sternotomy ◽  
Transverse Sinus ◽  
Right Atrial ◽  
Off Pump

Objective To evaluate the feasibility and results of isolated endoscopic pulmonary vein isolation for paroxysmal atrial fibrillation using robotics. Methods Between November 2004 and December 2005, 13 patients (38.5% female) underwent robotic pulmonary vein isolation at our institution. Mean age was 46.8 ± 8.4 years and mean preoperative duration of atrial fibrillation was 52.7 ±31.5 months. Indication for surgery was symptomatic drug-refractory paroxysmal atrial fibrillation or recurrence after percutaneous treatment (n = 3). Mean preoperative left atrial dimension was 38.5 ± 6.9 mm. The surgical procedure was performed off-pump as an isolated right chest approach. All procedures were performed using the Flex 10 microwave ablator (Guidant, Indianapolis, IN), which was positioned from the right side through the transverse sinus and around the 4 pulmonary veins. Postoperative drug regimen included sotalol and Coumadin. Mean follow-up was 8.5 ± 3.4 months. Results The procedure was successful in 11 patients. One patient needed conversion to median sternotomy for right pulmonary artery bleeding and a second patient had severe transverse sinus adhesions requiring conversion to a bilateral video-assisted small thoracotomy approach. No other morbidity occurred. Mean procedure time in successful cases was 2.7 ± 0.8 hours (range 1.7 to 4 hours). Permanent sinus rhythm was successfully restored in 10 of 13 patients (76.9% beyond 6 months). Nonsuccessful patients had markedly reduced symptoms and frequency of events. One patient required a left and another a right atrial flutter ablation during follow-up. Conclusions Robotic pulmonary vein isolation is a feasible procedure that has the potential to become a valid option in the treatment of paroxysmal atrial fibrillation.

scholarly journals A08-1 Recurrent atrial fibrillation after radiofrency disconnection of pulmonary veins: Recovery of left atrial- pulmonary vein conduction

EP Europace ◽  
2003 ◽  
Vol 4 (Supplement_2) ◽  
pp. B11-11
Author(s):  
M. Casella ◽  
G. Fassini ◽  
S. Riva ◽  
F. Giraldi ◽  
N. Trevisi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Recurrent Atrial Fibrillation

scholarly journals Safety and outcome of cryoballoon ablation versus radiofrequency catheter ablation of the pulmonary veins in patients with paroxysmal atrial fibrillation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
O H M A Riad ◽  
T Wong ◽  
A N Ali ◽  
M T Ibrahim ◽  
M A Abdelhamid ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
The Mean

Abstract Background Pulmonary vein isolation (PVI) has become the mainstay of catheter ablation of atrial fibrillation (AF). There are two commonly used methods to isolate the pulmonary veins, either point-by-point delivery of circumferential lesion sets around ipsilateral pulmonary veins using radiofrequency energy, or the application of the cryoballoon to the pulmonary vein antrum with occlusion of the vein ostium. The cryoballoon has proven to be a reliable alternative to radiofrequency ablation in acute and long-term freedom from AF. We describe our results using both modalities. Aim and Objectives to compare the safety and efficacy of cryoballoon (CB) ablation and radiofrequency (RF) ablation in treatment of paroxysmal atrial fibrillation. Patients and Methods Forty-four consecutive patients having paroxysmal AF underwent PVI using the second generation cryoballoon were compared to a retrospective cohort of 69 patients who had radiofrequency induced PVI, either by conventional RF catheter (n = 32), or a contact-force sensing-catheter (n = 37). The study took place at Ain Shams university hospitals and Royal Brompton & Harefield NHS trust. Patient data, procedural data and follow up data- at 3, 6 and 12 months- were collected and analysed. Recurrence was defined as documented AF or atrial arrhythmias with duration exceeding 30 seconds, either by 12 lead ECG or an ambulatory monitoring device. Results A total of 113 patients were studied. The mean age was 53.84 ± 15.01 for the CB group and 55.78 ± 14.84 for the RF group and females representing 40.9% vs 34.8% respectively. The mean procedural times in minutes were significantly less in the CB group (94.37 ± 39.32 vs 184.57 ± 88.19, p &lt; 0.0001), while the median fluoroscopy times were similar [30 (11.04 - 40) vs 37.25 (14.2 - 70), p = 0.172]. Procedural complications were comparable between the two groups (p = 0.06) with 1 patient (2.3%) having long term phrenic nerve paresis. At 1 year follow up, after an initial 90-day blanking period, recurrence rate of CB was similar to RF (27.3% vs 30.4% respectively, p = 0.719), the Kaplan Meier estimates of AF- free survival for a period of 1 year were comparable between both groups (log rank test, p = 0.606). Conclusion Cryoballoon is a feasible method for pulmonary vein isolation with similar success rates to radiofrequency ablation. Cryoballoon ablation is safe with shorter duration of the procedure.

scholarly journals Forecasting of recurrent atrial fibrillation after radiofrequency ablation of pulmonary veins using preoperative characteristics

2020 ◽  
Vol 7 (5) ◽  
pp. 6-16
Author(s):  
B. B. Bondarenko ◽  
A. V. Grigoryeva ◽  
L. A. Sokolova ◽  
V. A. Bart ◽  
I. A. Gorlova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Veins ◽  
First Year ◽  
Recurrent Atrial Fibrillation ◽  
Design And Methods ◽  
Preoperative Predictors ◽  
Af Recurrence

Background. Atrial fibrillation (AF) is the most frequent arrhythmia. The method of catheter radiofrequency ablation (CRA) of pulmonary veins (PV) does not guarantee the preservation of sinus rhythm. Determination of predictors of AF relapses dictates the need in systemic approach taking into account demographic and clinical-instrumental characteristics of patients. Objective. Determination of preoperative predictors of AF recurrence within 3 year after follow-up CRA PV.Design and methods. The study included 89 patients (50 men, 39 women; mean age 58 and 62 years respectively) followed during 3 years after CRA PV. The methods of principal components and discriminant analysis were used for analytical purposes. Results. The recurrence of AF was observed in 43 patients (48 %): during the first year — in 18 (43 %), during the second — in 16 (37 %), during the third — in 9 (20 %) cases. By consistently using the methods of descriptive and multivariant statistics a set of the preoperative indicators has been identified that distinguishes patients with AF relapses undergone CRA PV. It consists of the longivity of AF, the state of contractive myocardial function, the presence of ICD, cardioversion in the past and thyroid pathology. The contribution of modified risk factors: SBP level, BMI, tobacco smoking also are valued. Conclusion. Using of multivariant statistics allows to determine preoperative characteristics, which provide optimization of management of patients with AF.

scholarly journals Safety and Efficacy Using the Second-Generation Cryoballoon in Patients With Atrial Fibrillation and a Common Ostium of Inferior Pulmonary Veins

2021 ◽  
Vol 8 ◽  
Author(s):  
Hai-yang Xie ◽  
Xiao-gang Guo ◽  
Jian-du Yang ◽  
Jia-hui Li ◽  
Yan-qiao Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Second Generation ◽  
Anatomic Variation ◽  
Pulmonary Veins ◽  
Consecutive Series ◽  
Safety And Efficacy ◽  
Inferior Pulmonary Vein ◽  
The Right

Background: Common ostium of inferior pulmonary veins (COIPV) is a kind of pulmonary vein variation. The safety and efficacy of COIPV isolation using the second-generation cryoballoon (CB) ablation remain unknown.Methods: A total of 10 patients with COIPV from a consecutive series of 1,751 patients with atrial fibrillation (AF) were included. Pulmonary vein isolation (PVI) was performed using the second-generation CB.Results: The prevalence of a COIPV was 0.57% in this study. PVI was achieved in all pulmonary veins (PVs) without the need for a touch-up. A segmental freeze strategy was applied for each inferior PV, respectively. The mean number of freeze cycles of inferior PVs was 1.4 ± 0.5 for the left inferior pulmonary vein (LIPV), and 2.0 ± 0.9 for the right inferior pulmonary vein (RIPV). Pulmonary vein potential (PVP) of RIPV could not be monitored in real-time in three cases. Eight of 10 patients (80%) were free from atrial arrhythmias without the use of antiarrhythmic drugs during a follow-up period of 23.6 ± 12.9 months. No procedure-related complications occurred in any of the 10 patients.Conclusions: Common ostium of inferior pulmonary veins is a rare but challenging PV variant. PVI with this unusual anatomic variation using the second-generation 28-mm CB is effective and safe.

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