Morphometrical observation on the left atrium in human adults

Aim. To determine the left atrial dimensions, their ratios and relationships that characterize anatomy for left atrium structure in the normal human adult using the model of the atrial end-diastolic phase. Methods. We studied 54 heart specimens of subjects aged 3588 years who died from non-cardiac causes. The atrial end-diastolic phase was modeled by filling a specimen fixed in 1% formalin with liquid silicone. After silicone hardened, we performed morphometric measurements by a caliper. The data were processed by using a cluster, correlation and variance analysis. For pairwise comparison, we used the MannWhitney U-test or a two-sided t-test. Results. The article presents mean, standard deviation, median, 25th percentile and 75th percentile and coefficients of variation for the length, width and sagittal size of the left atrium, as well as the values of the distances between the pulmonary vein orifices, which characterize the dimensions of the left atrium posterior wall. Based on the left atrial size differences and their ratios, the specimens were divided into three clusters. The first (n1=23) and second clusters (n2=10) were represented by hearts with a cubic atrium; the second group differed from the first in the larger size of the left atrium. The third cluster (n3=21) included the hearts in which the largest left atrium size was the width, so the shape of the atria resembled a parallelepiped. The typical number of the pulmonary vein ostia we found in 91% of the specimens. The posterior wall of the left atrium, with a common number and topography of the ostia, were rectangle or an unequal trapezium in shape. We analyzed correlations between the sizes of the heart, left atrium and its posterior wall. We concretized the conceptual apparatus concerning the nomenclature and terminology of the left atrium anatomical structures. Conclusion. Based on the size ratio, two shape variations of the left atrium body can be identified: cubic or parallelepiped; cubic atria can be divided into large and small; the co-directional dimensions of the left atrial body and its posterior wall showed the strongest correlations.

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P1415Wide antral circumferential pulmonary vein isolation ablation using a novel balloon cryoablation catheter

EP Europace ◽

10.1093/europace/euaa162.203 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A P Martin ◽

M Fowler ◽

N Lever

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Pulmonary Veins ◽

Posterior Wall ◽

The Novel ◽

Median Treatment

Abstract Background Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established. Purpose To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC. Methods Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block. Results All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated. Conclusion Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium. Abstract Figure.

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Evaluation of left atrial size and function – from M-mode to 3D speckle-tracking echocardiography

Orvosi Hetilap ◽

10.1556/oh.2014.30007 ◽

2014 ◽

Vol 155 (41) ◽

pp. 1624-1631 ◽

Cited By ~ 3

Author(s):

Attila Nemes ◽

Tamás Forster

Keyword(s):

Left Atrium ◽

Left Atrial ◽

Functional Characterization ◽

Left Atrial Size ◽

Dynamic Motion ◽

Heart Chamber ◽

Atrial Size ◽

Exact Measurement ◽

Heart Cycle ◽

And Function

Left atrium is not a passive heart chamber, because it has a dynamic motion respecting heart cycle and, in accordance with its stretching, it releases atrial natriuretic peptides. Since in the course of certain invasive procedures the size of left atrium may change substantially, its exact measurement and functional characterization are essential. The aim of the present review is to summarize echocardiographic methods for the assessment of left atrial size and functional parameters. Orv. Hetil., 2014. 155(41), 1624–1631.

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Identification of deliberate catheter motion at the left atrial posterior wall during pulmonary vein isolation: Validity of respiratory motion adjustment

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.14945 ◽

2021 ◽

Author(s):

David R. Tomlinson ◽

Katie Biscombe ◽

John True ◽

Joanne Hosking ◽

Adam J. Streeter

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Respiratory Motion ◽

Posterior Wall ◽

Left Atrial Posterior

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Multicenter study of novel mapping technique to detect non-pulmonary vein triggers excluding the origin from left atrial posterior wall and superior vena cava

European Heart Journal ◽

10.1093/ehjci/ehaa946.0564 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Matsunaga ◽

Y Egami ◽

M Yano ◽

M Yamato ◽

R Shutta ◽

...

Keyword(s):

Pulmonary Vein ◽

Superior Vena Cava ◽

Left Atrial ◽

Medical Center ◽

Superior Vena ◽

Vena Cava ◽

Posterior Wall ◽

Mapping Technique ◽

Left Atrial Posterior ◽

Self Reference

Abstract Background It has been reported that elimination of non-pulmonary vein (PV) triggers after PV isolation is a good predictor of atrial tachyarrhythmia free survival. However, precise mapping of triggers outside from superior vena cava (SVC) or left atrial posterior wall (LAPW) are difficult. The aim of this study is to assess the efficacy of self-reference mapping technique to eliminate non-PV triggers originated from outside of primordial pulmonary vein area. Methods Total of 431 patients (446 procedures) underwent atrial fibrillation (AF) ablation in a hospital and in a medical center from January 2017 to March 2019. After isolation of PV, non-PV triggers were induced with isoproterenol and/or adenosine triphosphate. Reproducible non-PV triggers were targeted to ablate using following self-reference mapping technique: A trigger conducts centrifugally and the earliest site should be distinguished from other later activated sites. Using a PentaRay multipolar catheter, the operators annotated the earliest site of local activation and a reference tag was placed. The multipolar catheter was then moved to the reference tag and the process repeated. Ultimately, we identified clusters of early circumferential activation and ablated. Results A total of 32 non-PV triggers excluding the origin from LAPW and SVC were induced in 23 patients. Nineteen triggers (59%) were located in the right atrium and 13 triggers (41%) in the left atrium (Figure 1). All triggers were eliminated with ablation and AF was non-inducible in all patients at the end of the procedure. During the follow-up (529±270 days), 18 patients (77%) were free from atrial tachyarrhythmias after a 3-month blanking period. Three patients received additional ablation procedures for recurrent atrial arrhythmias. No non-PV triggers ablated during the previous procedure were observed. Conclusion A novel self-reference mapping technique is useful for eliminating non-PV triggers in terms of the short- and long-term success. Figure 1. Distribution of non-PV triggers Funding Acknowledgement Type of funding source: None

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A Giant Left Atrium due to Rheumatic Mitral Regurgitation, Outcome after Left Atrial Reduction Surgey with Mitral Valve Replacement

University Heart Journal ◽

10.3329/uhj.v14i1.38488 ◽

2018 ◽

Vol 14 (1) ◽

pp. 42-44

Author(s):

Istiaq Ahmed ◽

Sorower Hossain ◽

Ankan Kumar Paul

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Left Atrium ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Left Atrial ◽

Quick Recovery ◽

Replacement Surgery ◽

Atrial Size ◽

Giant Left Atrium

A trans-thoracic echocardiography and chest radiograph of a 26 year old lady diagnosed as rheumatic mitral regurgitation with atrial fibrillation revealed a giant left atrium of 10.9 cm size with symptoms of dyspnoea and palpitation. The patient was treated with left atrial size reduction along with mitral valve replacement surgery and showed an excellent and quick recovery with total disappearance of symptoms and restoration of sinus rhythm only within few days.University Heart Journal Vol. 14, No. 1, Jan 2018; 42-44

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Pulmonary vein antrum isolation leads to a significant decrease of left atrial size

EP Europace ◽

10.1093/europace/euq464 ◽

2010 ◽

Vol 13 (3) ◽

pp. 371-375 ◽

Cited By ~ 31

Author(s):

I. E. Hof ◽

B. K. Velthuis ◽

S.-M. Chaldoupi ◽

F. H. Wittkampf ◽

V. J. van Driel ◽

...

Keyword(s):

Pulmonary Vein ◽

Left Atrial ◽

Left Atrial Size ◽

Atrial Size ◽

Pulmonary Vein Antrum Isolation

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A Patient with Giant Left Atrium Undergoes Orthotopic Heart Transplantation

Texas Heart Institute Journal ◽

10.14503/thij-12-2948 ◽

2014 ◽

Vol 41 (1) ◽

pp. 87-90 ◽

Cited By ~ 2

Author(s):

Sergey Y. Boldyrev ◽

Murat K. Lepshokov ◽

Igor I. Yakuba ◽

Kirill O. Barbukhatty ◽

Vladimir A. Porhanov

Keyword(s):

Left Atrium ◽

Left Atrial ◽

Left Atrial Volume ◽

Posterior Wall ◽

Orthotopic Heart Transplantation ◽

Mechanical Prosthesis ◽

Size Mismatch ◽

Giant Left Atrium ◽

Left Atrial Posterior ◽

Rheumatic Heart

We present a novel technique for resolving the problem of radical size mismatch at the time of orthotopic transplantation. A 48-year-old man presented with chronic rheumatic heart disease and a giant left atrium. Twenty-three years before, he had undergone mitral valve replacement with a mechanical prosthesis. At the time of the repeated intervention, the volume of his left atrium was 350 mL. Surgical features of the transplantation included approximation of the pulmonary vein ostia by gathering sutures intentionally, in order to decrease the area of the left atrial posterior wall and thereby enable appropriate coaptation with the donor left atrium. After the operation, left atrial volume had been reduced to 60 mL.

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