Morphologic analysis of left atrial anatomy by magnetic resonance angiography in patients with atrial fibrillation: A large single center experience

Matteo Anselmino, Alessandro Blandino, Serena Beninati, Chiara Rovera, Carlo Boffano, Marco Belletti, Domenico Caponi, Marco Scaglione, Federico Cesarani, Fiorenzo Gaita

Research output: Contribution to journalArticlepeer-review

Abstract

LA and PV Anatomy in Patients With AF. Introduction: Although transcatheter atrial fibrillation (AF) ablation requires accurate anatomic knowledge, pulmonary vein (PV) anatomy has not been fully investigated. Aim of this study is to describe left atrium (LA) and PV anatomy by magnetic resonance angiography (MRA) in a large cohort of patients with AF. Methods: MRA was performed in 473 patients preceding transcatheter AF ablation (paroxysmal 60.9%; persistent 39.1%). The Venice Chart classification was used to classify PV branching patterns. Results: About 40% of the patients presented typical PV branching pattern (2 left and 2 right PVs). A representative number of patients presented a common left trunk (19.9% and 11.0% short and long, respectively). A right middle PV was described in 12.5% and 2 right middle PVs in 1.5% patients. The remaining patients presented other complex, previously unclassified patterns: 6.3% presented an accessory PV originating from LA areas not describable as right or "upper" and 8.7% a common left trunk plus right middle PV. Diameters and circumference of each PV, LA, and LA appendage volumes resulted larger in patients presenting persistent compared to paroxysmal AF (P <0.001). Conclusion: This study highlights that "typical" PV branching pattern is not a common finding. That 25.6% of the patients present at least 1 accessory PV needs to be kept in careful consideration when planning and performing transcatheter AF ablation. In addition, not only LA volume, but also each PV ostia and LA appendage are significantly enlarged in patients with persistent compared to paroxysmal AF.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume22
Issue number1
DOIs
Publication statusPublished - Jan 2011

Keywords

  • atrial fibrillation
  • catheter ablation
  • left atrium
  • magnetic resonance imaging
  • pulmonary veins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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