INTRODUCTION: With the increasing use of pre-procedural imaging techniques such as magnetic resonance imaging (MRI) and their integration with electroanatomic mapping systems in catheter ablation for atrial fibrillation (AF), atypical anatomy of the pulmonary veins (PV), left atrium (LA) and their relationship to the thoracic aorta is increasingly recognized. OBJECTIVE: To characterize atypical LA-PV anatomies revealed by pre-procedural MRI and their impact on the safety and efficacy of AF ablation procedures. MATERIALS AND METHODS: We reported four patients who underwent AF ablation in our electrophysiology laboratory within the last year who had atypical LA-PV anatomy due to aorta compression recognized by pre-procedural three-dimensional (3D) MRI and anatomic segmentation. Twelve matched control cases without aorta compression were selected for comparison of LA-PV measurements. RESULTS: All four patients in this study had a normal-sized descending thoracic aorta that compressed the left atrium, and all patients had evidence of left inferior PV narrowing secondary to external compression. Two patients also had anterior LA compression leading to posteriorly displaced interatrial septum. Isolation was not achieved in some PVs due to anatomic restraints, concern regarding risks of aortic injury and worsening pulmonary vein stenosis. There were no immediate or short-term complications. CONCLUSIONS: Extrinsic compression by the descending aorta on the LA and PV leading to LA compression and/or preexisting PV stenosis is uncommon but has potentially important implications on the overall safety and efficacy of AF ablation procedures. Pre-procedural imaging plays an important role in assessing such anatomic variations and planning of the procedures in order to minimize the risk of PV stenosis and aortic injury.
INTRODUCTION: With the increasing use of pre-procedural imaging techniques such as magnetic resonance imaging (MRI) and their integration with electroanatomic mapping systems in catheter ablation for atrial fibrillation (AF), atypical anatomy of the pulmonary veins (PV), left atrium (LA) and their relationship to the thoracic aorta is increasingly recognized. OBJECTIVE: To characterize atypical LA-PV anatomies revealed by pre-procedural MRI and their impact on the safety and efficacy of AF ablation procedures. MATERIALS AND METHODS: We reported four patients who underwent AF ablation in our electrophysiology laboratory within the last year who had atypical LA-PV anatomy due to aorta compression recognized by pre-procedural three-dimensional (3D) MRI and anatomic segmentation. Twelve matched control cases without aorta compression were selected for comparison of LA-PV measurements. RESULTS: All four patients in this study had a normal-sized descending thoracic aorta that compressed the left atrium, and all patients had evidence of left inferior PV narrowing secondary to external compression. Two patients also had anterior LA compression leading to posteriorly displaced interatrial septum. Isolation was not achieved in some PVs due to anatomic restraints, concern regarding risks of aortic injury and worsening pulmonary vein stenosis. There were no immediate or short-term complications. CONCLUSIONS: Extrinsic compression by the descending aorta on the LA and PV leading to LA compression and/or preexisting PV stenosis is uncommon but has potentially important implications on the overall safety and efficacy of AF ablation procedures. Pre-procedural imaging plays an important role in assessing such anatomic variations and planning of the procedures in order to minimize the risk of PV stenosis and aortic injury.
Authors: Ritsushi Kato; Lars Lickfett; Glenn Meininger; Timm Dickfeld; Richard Wu; George Juang; Piamsook Angkeow; Jennifer LaCorte; David Bluemke; Ronald Berger; Henry R Halperin; Hugh Calkins Journal: Circulation Date: 2003-04-07 Impact factor: 29.690
Authors: Peter M Kistler; Kim Rajappan; Mohammed Jahngir; Mark J Earley; Stuart Harris; Dominic Abrams; Dhiraj Gupta; Reginald Liew; Stephen Ellis; Simon C Sporton; Richard J Schilling Journal: J Cardiovasc Electrophysiol Date: 2006-10
Authors: M Haïssaguerre; P Jaïs; D C Shah; A Takahashi; M Hocini; G Quiniou; S Garrigue; A Le Mouroux; P Le Métayer; J Clémenty Journal: N Engl J Med Date: 1998-09-03 Impact factor: 91.245
Authors: Hakan Oral; Christoph Scharf; Aman Chugh; Burr Hall; Peter Cheung; Eric Good; Srikar Veerareddy; Frank Pelosi; Fred Morady Journal: Circulation Date: 2003-10-13 Impact factor: 29.690
Authors: Fred H M Wittkampf; Evert-Jan Vonken; Richard Derksen; Peter Loh; Birgitta Velthuis; Eric F D Wever; Lucas V A Boersma; Benno J Rensing; Maarten-Jan Cramer Journal: Circulation Date: 2003-01-07 Impact factor: 29.690