PURPOSE: The pulmonary venoatrial junction (PVAJ) has recently received attention due to the widespread use of catheter ablation for atrial fibrillation. However, the literature lacks a consensus in the definition of the PVAJ. We aim to review the inconsistent definitions for the PVAJ and related implications in imaging and catheter ablation for atrial fibrillation. RESULTS: The PVAJ as described by embryology, gross anatomy, histology and imaging is ambiguous, leading to disparities in its definition. Because of differing definitions of the PVAJ, there is a broad range in the prevalence of anatomic variations, including (1) percentage of common pulmonary veins (10-79% on the left), (2) supernumerary pulmonary veins (10-42%) and (3) ostial diameter and shape. We postulate several reasons for this broad range in the described prevalence of anatomic variation of the PV as follows: (1) different definitions of the PVAJ, (2) different vantage points, (3) different imaging modalities, and (4) different prevalence of anatomic variants among different study populations. CONCLUSIONS: The ambiguous PVAJ with its gradual transition from the left atrium to the pulmonary veins defies precise definition even though it plays an important role in the management of atrial fibrillation. Physicians should be aware of variability in the language used to describe the PVAJ and resultant discrepancy in reported anatomical information.
PURPOSE: The pulmonary venoatrial junction (PVAJ) has recently received attention due to the widespread use of catheter ablation for atrial fibrillation. However, the literature lacks a consensus in the definition of the PVAJ. We aim to review the inconsistent definitions for the PVAJ and related implications in imaging and catheter ablation for atrial fibrillation. RESULTS: The PVAJ as described by embryology, gross anatomy, histology and imaging is ambiguous, leading to disparities in its definition. Because of differing definitions of the PVAJ, there is a broad range in the prevalence of anatomic variations, including (1) percentage of common pulmonary veins (10-79% on the left), (2) supernumerary pulmonary veins (10-42%) and (3) ostial diameter and shape. We postulate several reasons for this broad range in the described prevalence of anatomic variation of the PV as follows: (1) different definitions of the PVAJ, (2) different vantage points, (3) different imaging modalities, and (4) different prevalence of anatomic variants among different study populations. CONCLUSIONS: The ambiguous PVAJ with its gradual transition from the left atrium to the pulmonary veins defies precise definition even though it plays an important role in the management of atrial fibrillation. Physicians should be aware of variability in the language used to describe the PVAJ and resultant discrepancy in reported anatomical information.
Authors: J B Moubarak; J V Rozwadowski; C T Strzalka; W R Buck; W S Tan; G F Kish; T Kisiel; H C Fronc; J D Maloney Journal: Pacing Clin Electrophysiol Date: 2000-11 Impact factor: 1.976
Authors: Benoit Ghaye; David Szapiro; Jean-Nicolas Dacher; Luz-Maria Rodriguez; Carl Timmermans; David Devillers; Robert F Dondelinger Journal: Radiographics Date: 2003-10 Impact factor: 5.333
Authors: Eduardo B Saad; Nassir F Marrouche; Cynthia P Saad; Edward Ha; Dianna Bash; Richard D White; John Rhodes; Lourdes Prieto; David O Martin; Walid I Saliba; Robert A Schweikert; Andrea Natale Journal: Ann Intern Med Date: 2003-04-15 Impact factor: 25.391
Authors: Chandreaekhar R Vasamreddy; Vinod Jayam; Lars Lickfett; Khurram Nasir; David J Bradley; Zayd Eldadah; Timm Dickfeld; Kevin Donahue; Henry S Halperin; Ronald Berger; Hugh Calkins Journal: J Cardiovasc Electrophysiol Date: 2004-01