Comparison of pulmonary veins in patients with and without atrial fibrillation using multidedector computed tomographic angiography

Objectives: Atrial fibrilation (AF) develops from an arrhythmogenic ectopic focus, which triggers the vicious circle that creates arrhythmias. Arrhythmogenic foci are often located in the transition areas between the pulmonary veins and the left atrial endothelium. This study aims to compare the pulmonary vein anatomy of patients with and without AF using multidetector computed tomographic (MDCT) angiography and to evaluate the relationship between the presence of pulmonary vein variations and the development of AF. Methods: Seventy cases (38 males, 32 females) aged between 23 and 75 (mean age: 49.9 ± 13.3 years) were included in this study. This study consisted of 20 patients undergoing endovascular radiofrequency catheter ablation with AF and 50 participants (control) without AF. MDCT angiography examination was performed for the evaluation of pulmonary vein anatomy and variations. Results: Normal pulmonary vein anatomy was observed in 30% (n = 6) of the study group, 60% (n = 30) of the control group, and 51.4% (n = 36) of the total of both groups. Variation in pulmonary vein anatomy (accessory pulmonary vein or common ostium) was detected in 48.6% (n = 34/70) of the cases. The most common variation was the presence of accessory pulmonary vein (35.7%). Common ostium was found to be the second most common variation (12.8%). All common ostia were localized on the left side. Early branching of pulmonary veins was detected in 41 (58.5%) of 70 cases. Conclusions: Accesory pulmonary vein, common ostium and early branching are more frequently present in patients with AF.

Keywords:

Atrial fibrillation pulmonary veins, multidetector computed tomographic angiography,

PDF

___

1. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Lewy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946-52.
2. Ezekowitz MD, Netrebko PI. Anticoagulation in management of atrial fibrillation. Curr Opin Cardiol 2003;18:26-31.
3. Pasty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, et al. Incidence of the risk factors for the atrial fibrillation in older adults. Circulation 1997;96:2555-61.
4. Monterio MM, Saraıva C, Branco JC. Characterization of pulmonary vein morphology using multi-detector row CT study prior to radiofrequency ablation for atrial fibrillation. Rev Port Cardiol 2009;28:545-59.
5. Hertervig E, Kongstad O, Ljungstrom E, Olsson B, Yuan S. Pulmonary vein potentials in patients with and without atrial fibrillation. Europace 2008;10:692-7.
6. Jaïs P, Haïssaguerre M, Shah DC, Chouairi S, Gencel L, Hocini M, et al. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 1997;95:572-6.
7. Benini K, Marini M, Greco MD, Nollo G, Manera V, Centonze M. Role of multidedector computed tomograhpy in the anatomical definition of the left atrium-pulmonary vein complex in patients with atrial fibrillation. Personal experience and pictoral assay. Radiol Med 2008;113:779-98.
8. Skowerska W, Skowerski M, Wnuk-Wojnar A, Hoffmann A, Nowak S, Gola A, et al. Comparison of pulmonary veins anatomy in patients with and without atrial fibrillation: analysis by multislice tomography. Int J Cardiol 2011;146:181-5.
9. Stanford W, Breen JF. CT evaluation of left pulmonary venous anatomy. Int J Cardio Imag 2005;21:133-9.
10. Ito H, Dajani KA. Evalation of the pulmonary veins and left atrial volume using multidedector computed tomography in patients undergoing catheter ablation for atrial fibrillation. Curr Cardiol Rev 2009:5;17-21.
11. Pasty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, et al. Incidence of the risk factors for the atrial fibrillation in older adults. Circulation 1997;96:2555-61.
12. Bialy D, Lehmann MH, Schumacher DN, Steinman RT, Meissner MD. Hospitalization for arrhythmias in the United States: importance of atrial fibrillation. J Am Coll Cardiol 1992;19:41A.
13. Cronin P, Sneider MB, Kazerooni EA, Kelly AM, Scharf C, Oral H, et al. MDCT of the left atrium and pulmonary veins in planning radiofrequency ablation for atrial fibrillation: a how-to guide. AJR 2004;183:767-78.
14. Ghaye B, Szapiro D, Dacher JN, Rodriguez LM, Timmermans C, Devillers D, et al. Percutaneous ablation for atrial fibrillation: the role of cross-sectional imaging. RadioGraphics 2003;23:19-33.
15. Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66.
16. Ho SY, Sanchez-Quintana D, Cabrera JA, Anderson RH. Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 1999;10:1525-33.
17. Ho SY, Cabrera JA, Tran VH, Farré J, Anderson RH, Sánchez-Quintana D. Architecture of the pulmonary veins: relevance to radiofrequency ablation. Heart 2001;86:265-70.
18. Haïssaguerre M, Jaïs P, Shah DC, Garrigue S, Takahashi A, Lavergne T, et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000;101:1409-17.
19. Krause GR, Lubert M. The Anatomy of the bronchopulmonary segments: clinical applications. Radiology 1951;56:333-54.
20. Gurney JW. Cross-sectional physiology of the lung. Radiology 1991;178:1-10.
21. Marom EM, Herndon JE, Kim YH, McAdams HP. Varitions in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology 2004;230:824-9.
22. Wannasopha Y, Oilmungmool N, Euathrongchit J. Anatomical variations of pulmonary venous drainage in Thai people: multidetector CT study. Biomed Imaging Interv J 2012;8:e4.
23. Koçyiğit D, Gürses KM, Yalçın MU, Türk G, Evranos B, Canpolat U, et al. Pulmonary vein anatomy and its variations in a Turkish atrial fibrillation cohort undergoing cryoballoon-based catheter ablation. Turk Kardiyol Dern Ars 2017;45:42-8.
24. Scharf C, Sneider M, Case I, Chugh A, Lai SWK, Pelosi F, et al. Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography. Cardiovasc Electrophysiol 2003;14:150-5.
25. Tsao HM, Wu MH, Yu WC, Tai CT, Lin YK, Hsieh MH, et al. Role of right middle pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2001;12:1353-7.
26. McLellan AJ, Ling LH, Ruggiero D, Wong MCG, Walters TE, Nisbet A, et al. Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation. Heart Rhythm 2014;11:549-56.
27. Altinkaynak D, Koktener A. Evaluation of pulmonary venous variations in a large cohort: multidetector computed tomography study with new variations. Wien Klin Wochenschr 2019;131:475-84.
28. Jongbloed MRM, Dirksen MS, Bax JJ, Boersma E, Geleijns K, Lamb HJ, et al. Atrial fibrillation: multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation -- initial experience. Radiology 2005;234:702-9.
29. Thorning C, Hamady M, Liaw JVP, Juli C, Lim PB, Dhawan R, et al. CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation. Clin Imaging 2011;35:1-9.

ISSN: 2149-3189
Yayın Aralığı: Yılda 6 Sayı
Başlangıç: 2015
Yayıncı: Prusa Medikal Yayıncılık Limited Şirketi

Arşiv