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Journal of Interventional Cardiac Electrophysiology

Published in:

01-08-2016

Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies

Authors: Faisal M. Merchant, Mathew R. Levy, Shahriar Iravanian, Edward C. Clermont, Heval M. Kelli, Robert L. Eisner, Mikhael F. El-Chami, Angel R. Leon, David B. Delurgio

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2016

Abstract

Background

Novel atrial fibrillation (AF) ablation tools have been designed to facilitate “single-shot” pulmonary vein (PV) isolation using multi-electrode or balloon-based catheters. However, in contrast to point-by-point radiofrequency ablation, these tools may be more dependent on suitable PV anatomy to achieve circumferential PV isolation.

Methods

Three hundred and twenty-two patients underwent gadolinium-enhanced cardiac magnetic resonance angiography to delineate PV anatomy prior to initial AF ablation. Long (a) and short (b) axis measurements of the PV orifice were used to calculate the eccentricity index of the PV ostium.

Results

Long axis dimensions of the left superior PV were 18.2 ± 3.3 mm, left inferior PV 17.7 ± 3.9 mm, right superior PV (RSPV) 20.4 ± 4.3, and right inferior PV 18.7 ± 4.7 mm. The long axis dimension of the RSPV was significantly larger than other PVs (p < 0.001). Forty-two patients (13 %) had at least one PV with a long axis dimension >25 mm and 16 patients (5 %) had at least one PV with a long axis dimension >28 mm. Left-sided PV ostia were significantly more ellipse-shaped than the right-sided PVs, which tended to be more spherical. A significant positive correlation was noted between increasing PV size and increased orifice eccentricity.

Conclusions

In this large cohort undergoing initial AF ablation, over 10 % of patients had at least one standard PV with a dimension >25 mm. Additionally, significant differences were noted between left- and right-sided veins with regard to orifice eccentricity. These findings have implications for the design of AF ablation tools and may account for differential isolation rates between PVs noted in some recent studies of novel ablation technologies.

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Title: Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies
Authors: Faisal M. Merchant
Mathew R. Levy
Shahriar Iravanian
Edward C. Clermont
Heval M. Kelli
Robert L. Eisner
Mikhael F. El-Chami
Angel R. Leon
David B. Delurgio
Publication date: 01-08-2016
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 2/2016
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-016-0106-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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