Document Detail

Anatomic characteristics of the left atrial isthmus in patients with atrial fibrillation: lessons from computed tomographic images.
MedLine Citation:
PMID:  17096659     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Left atrial (LA) isthmus ablation was reported to improve the success rate of catheter ablation of paroxysmal atrial fibrillation (AF). LA isthmus ablation could also cure a subset of LA flutter. Therefore, understanding the anatomy of the LA isthmus is important for performing the ablation effectively. METHODS AND RESULTS: Group I included 45 patients (40 male, mean age = 50 +/- 13 years) with paroxysmal AF who underwent catheter ablation. Group II included 45 patients (37 male, mean age = 54 +/- 10 years) without a history of AF. They underwent a 16-slice multidetector computed tomography (MDCT) scan to delineate the LA structures before the ablation procedure. The average length of the LA isthmus was longer in group I than in group II (lateral isthmus: 3.30 +/- 0.68 vs 2.71 +/- 0.60 cm, P < 0.001; medial isthmus: 5.12 +/- 0.94 vs 4.45 +/- 0.63 cm, P < 0.001), and morphological patterns of lateral and medial isthmus were similar between groups. In addition, the average depth of lateral isthmus was similar between groups (0.62 +/- 0.32 vs 0.55 +/- 0.33 cm, P = 0.41), but the average depth of medial isthmus was larger in group I than in group II (0.60 +/- 0.32 vs 0.44 +/- 0.25 cm, P = 0.01). The medial isthmus had more ridges, as compared to the lateral isthmus (13% vs 0%, P = 0.026). Furthermore, the distances between esophagus and lateral isthmus were longer in group I than in group II (at the middle of isthmus and mitral annulus level: 21.0 +/- 4.8 vs 18.4 +/- 6.0 mm, P < 0.001; and 37.1 +/- 5.7 vs 29.6 +/- 8.1 mm, P < 0.001, respectively). CONCLUSION: The LA isthmus was longer in the AF patients. The morphology of the isthmus was variable. Compared with the lateral isthmus, the medial isthmus was longer and had more ridges. A peculiar configuration of the isthmus provided by CT images could influence the ablation strategy.
Shuo-Ju Chiang; Hsuan-Ming Tsao; Mei-Han Wu; Ching-Tai Tai; Shih-Lin Chang; Wanwarang Wongcharoen; Yenn-Jiang Lin; Li-Wei Lo; Yi-Jen Chen; Ming-Huei Sheu; Cheng-Yen Chang; Shih-Ann Chen
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Publication Detail:
Type:  Journal Article     Date:  2006-11-10
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  17     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2007-01-22     Completed Date:  2007-02-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1274-8     Citation Subset:  IM    
Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, Taiwan.
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MeSH Terms
Anthropometry / methods
Atrial Fibrillation / epidemiology,  pathology*,  radiography*
Heart Atria / pathology*,  radiography*
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Taiwan / epidemiology
Tomography, X-Ray Computed / statistics & numerical data*

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