| Three-dimensional analysis of pulmonary venous ostial and antral anatomy: implications for balloon catheter-based pulmonary vein isolation. | |
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MedLine Citation:
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PMID: 16643395 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Balloon ablation catheters using various energy sources are being developed to perform pulmonary vein (PV) isolation to treat atrial fibrillation. Prior evaluations of 2D CT/MR images are limited by the frequent elliptical shape of the PV ostia, the nonorthogonal orientation of the PVs to the left atrial (LA) chamber, and difficulty in appreciating through-slice curvature. To provide anatomical data relevant to balloon catheter ablation, 3D surface reconstructions of LA-PVs were generated and analyzed to define ostial architecture and size. METHODS AND RESULTS: Using MRI datasets obtained from 101 paroxysmal AF patients, the LA-PVs were segmented to generate 3D LA-PV surface reconstructions. Using both external and endoluminal projections, the PV ostial and antral regions were identified and evaluated. In the left PVs, a common left-sided ostium was identified in 94 patients, with an ostial circumference of 95 +/- 15 mm. Branching of the left PVs occurred 0-5 mm away from the common left ostium in 43 patients (43%), 5-15 mm away from the common os in 37 patients (37%), and >15 mm away from the common os in 14 patients (14%). In patients with either distinct left PV ostia, or common os <15 mm (87 patients), the individual LSPV/LIPV ostial circumferences were 67 +/- 12 mm and 58 +/- 9 mm, respectively. Mean left antral circumference was 114 +/- 17 mm. In the right PVs, the ostial circumferences of the RSPV/RIPV were 68 +/- 11 mm and 66 +/- 11 mm, respectively. Mean right antral circumference was 107 +/- 19 mm. Assuming ideal deformation of the LA chamber anatomy, the minimal diameters of a balloon ablation catheter required to isolate 95% of the RSPV, RIPV, LSPV, LIPV, LCPV, left antrum, and right antrum are 29 mm, 28 mm, 29 mm, 24 mm, 40 mm, 46 mm, and 47 mm, respectively. CONCLUSION: Analysis of 3D surface reconstructions of LA-PV anatomy reveals that balloon catheter-based ablation of the PVs is likely feasible in most patients, but balloon ablation of the common PV antra would be problematic. |
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Authors:
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Jameel Ahmed; Sandeep Sohal; Zachary J Malchano; Godtfred Holmvang; Jeremy N Ruskin; Vivek Y Reddy |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 17 ISSN: 1045-3873 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2006 Mar |
Date Detail:
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Created Date: 2006-04-28 Completed Date: 2006-06-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 251-5 Citation Subset: IM |
Affiliation:
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Cardiac Arrhythmia Service, Massachusetts General Hospital-Harvard Medical School, Boston 02114, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Atrial Fibrillation
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surgery* Catheter Ablation / methods* Female Humans Image Processing, Computer-Assisted Imaging, Three-Dimensional* Magnetic Resonance Imaging* Male Middle Aged Pulmonary Veins / anatomy & histology* Retrospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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