scholarly journals Anatomical correlation between left atrium pulmonary vein ablation targets of atrial fibrillation and adjacent bronchi and pulmonary arteries by MSCT

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan-Jing Wang ◽  
Huan Sun ◽  
Xiao-Fei Fan ◽  
Meng-Chao Zhang ◽  
Ping Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Arteries ◽  
Contact Points ◽  
Pulmonary Vein Ablation ◽  
Adjacent Structures ◽  
Anatomical Correlation ◽  
The Right

Abstract Background The 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. Methods Data 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. Results The 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). Conclusions The 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.

scholarly journals Variations in Draining Patterns of Right Pulmonary Veins at the Hilum and an Anatomical Classification

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
M. S. Rajeshwari ◽  
Priya Ranganath
Keyword(s):  
Atrial Fibrillation ◽  
Mr Imaging ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Ct Angiography ◽  
Pulmonary Veins ◽  
Inferior Pulmonary Vein ◽  
Superior Pulmonary Vein ◽  
Anatomical Classification ◽  
The Right

Pulmonary veins carry oxygenated blood from the lungs to the left atrium. Variations are quite common in the pattern of drainage. The present study was undertaken to evaluate the incidence of different draining patterns of the right pulmonary veins at the hilum by dissecting the human fixed cadaveric lungs. Clinically, pulmonary veins have been demonstrated to often play an important role in generating atrial fibrillation. Hence, it is important to look into the anatomy of the veins during MR imaging and CT angiography. In 53.8% of cases, the right superior lobar vein and right middle lobar vein were found to be united together to form the right superior pulmonary vein. In contrast to this, in 11.53% of cases, right middle lobar vein united with the right inferior lobar vein to form the right inferior pulmonary vein, while in 26.9% of cases, the right superior lobar vein, right middle lobar vein, and right inferior lobar vein drained separately.

P962Circumferential pulmonary vein ablation in combination with a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (8.5-year follow-up)

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Kettering
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Pulmonary Vein Ablation ◽  
Group A ◽  
Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 220 patients (114 men, 106 women; mean age 69 years (SD ± 14 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96 and 102 months after the ablation procedure. The long-term follow-up data was compared to 220 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-one out of 220 patients (23.2 %) in group A and 53 out of 220 patients (24.1 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 102-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 125/220 patients (56.8 %) in group A and in 103/220 patients (46.8 %) in group B. In 66/220 patients (30.0 %) in group A and 59/220 patients (26.8 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 29 patients (13.2 %) in group A, a recurrence of persistent atrial fibrillation (&gt; 48 hours) was revealed by the long-term recordings (group B: 58 patients (26.4 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.

scholarly journals A study on pulmonary venous ostia pattern in the left atrium and its clinical applications

2018 ◽  
Vol 7 (04) ◽  
pp. 201-204
Author(s):  
Rajesh S. ◽  
Vijaya Kumar S. ◽  
Manikanda Reddy V.
Keyword(s):  
Atrial Fibrillation ◽  
Radio Frequency ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Anatomical Variation ◽  
Pulmonary Veins ◽  
Clinical Applications ◽  
Ectopic Beats ◽  
The Right ◽  
Formalin Fixed

Abstract Background & aims : Normally four pulmonary veins open into the left atrium. Frequently there are variations in the number of pulmonary veins opening in to the left atrium. Ectopic beats in atrial fibrillation commonly originates from the ostia of the pulmonary veins. The treatment of atrial fibrillation is by radio frequency ablation of the focus of origin and hence the knowledge of anatomical variation of pulmonary veins is necessary to find the ectopic focus in the origin of atrial fibrillation. Materials and Method : In this study the variation of pulmonary venous ostia pattern in the left atrium was studied in 80 formalin fixed adult cadaveric hearts. Results and Conclusion : 63 hearts showed no variation in the pulmonary venous ostia pattem which accounts for 78.75%, rest of the 17 hearts showed variation in the pulmonary venous ostia which accounts for 21.25%, the variation in the number of pulmonary veins was slightly higher for the left side [11.25%] when compared to the right sided variation [ 10%], the number of hearts which showed bilateral variation was noted in 2 hearts - both showed a single pulmonary vein opening on either side which accounts for 2.5%

6120Anatomical investigation of the sinus node artery and the radiofrequency application sites for catheter ablation of atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Suzuki ◽  
S Eguchi ◽  
D Ishihara
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Sinus Node ◽  
Sinus Node Dysfunction ◽  
Application Site ◽  
Sinus Node Artery ◽  
Endocardial Surface ◽  
The Right

Abstract Background Circumferential pulmonary vein isolation is an established therapy for selected patients with atrial fibrillation (AF). Three-dimensional imaging modalities can be useful to establish the mechanism of a procedure-related complication. Purpose The purpose of this study was to investigate the course of the sinus node artery (SNA) and the coronary arterial injury during catheter ablation of AF. Methods In the 254 consecutive patients, the courses of the SNA were recorded using multislice computed tomography. Results The visualization rate was 96.9% (246/254). Of 246 patients, 287 SNAs were detected among which 114 (44.9%) originated from the right coronary artery, 91 (35.9%) from the left circumflex (Cx) artery, and 41 (16.1%) from both the right and Cx artery. Only SNAs originated from the Cx artery coursed along the left atrium. Only in 2 patients, SNAs coursed endocardial surface of the left atrium. In one of these 2 patients, sinus node dysfunction developed just after the ablation of the right superior pulmonary vein ostium, requiring a permanent pacemaker implantation. The SNA originated from the distal Cx artery, and precisely coursed endocardial surface at the radiofrequency application site. Coronary angiography revealed the occlusion of the SNA at that site, and the SNA occlusion was presumed the cause of the sinus node dysfunction in this patient. Conclusion The recognition of the course of the SNA is important in minimizing the risk of sinus node dysfunction during catheter ablation of AF.

scholarly journals Circumferential pulmonary vein ablation with or without a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (9-year follow-up)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kettering
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Pulmonary Vein Ablation ◽  
Group A ◽  
Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 240 patients (125 men, 115 women; mean age 70 years (SD ± 15 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96, 102 and 108 months after the ablation procedure. The long-term follow-up data was compared to 240 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-five out of 240 patients (22.9%) in group A and 58 out of 240 patients (24.2%) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 108-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 135/240 patients (56.3%) in group A and in 111/220 patients (46.3%) in group B. In 73/240 patients (30.4%) in group A and 66/240 patients (27.5%) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 32 patients (13.3%) in group A, a recurrence of persistent atrial fibrillation (&gt;48 hours) was revealed by the long-term recordings (group B: 63 patients (26.2%)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up. Funding Acknowledgement Type of funding source: None

The relationship between scimitar syndrome, so-called scimitar variant, meandering right pulmonary vein, horseshoe lung and pulmonary arterial sling

2006 ◽  
Vol 16 (3) ◽  
pp. 300-304 ◽  
Author(s):  
Shi-Joon Yoo ◽  
Abdulmajeed Al-Otay ◽  
Paul Babyn
Keyword(s):  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Arteries ◽  
Scimitar Syndrome ◽  
Horseshoe Lung ◽  
Pulmonary Arterial ◽  
The Right ◽  
The Relationship

We report a case in which a meandering right pulmonary vein connecting to the left atrium is associated with hypoplasia of the right lung, horseshoe lung, abnormal pulmonary lobation, and abnormal branching of the pulmonary arteries. We discuss its relationship to the so-called scimitar variant, and to the scimitar syndrome itself.

scholarly journals Metastatic renal cell carcinoma extending to the left atrium through the inferior pulmonary vein

2021 ◽  
Author(s):  
Alan G Dawson ◽  
Cathy J Richards ◽  
Leonidas Hadjinikolaou ◽  
Apostolos Nakas
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Pulmonary Veins ◽  
Lower Lobe ◽  
Inferior Pulmonary Vein ◽  
The Right

Abstract Metastatic renal cell carcinoma with involvement through the pulmonary veins to the left atrium is very rare. We report the case of a 70-year-old male with metastatic renal cell carcinoma to the right lower lobe of the lung abutting the inferior pulmonary vein with extension to the left atrium without pre-operative evidence. Surgical resection was achieved through a posterolateral thoracotomy. Lung masses that abut the pulmonary veins should prompt further investigation with a pre-operative transoesophageal echocardiogram to minimize unexpected intraoperative findings.

scholarly journals P.1.14 Atrial conduction changes and pulmonary vein arrhythmogenicity following pulmonary vein ablation for atrial fibrillation

EP Europace ◽  
2003 ◽  
Vol 4 (Supplement_1) ◽  
pp. A36-A36
Author(s):  
D. Husser ◽  
A. Bollmann ◽  
S. Kang ◽  
A.K. Bhandari ◽  
D.S. Cannom
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Ablation
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