Three-dimensional anatomy of the left atrium by magnetic resonance angiography: Implications for catheter ablation for atrial fibrillation
Three-dimensional anatomy of the left atrium by magnetic resonance angiography: Implications for catheter ablation for atrial fibrillation
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DOI：
10.1111/j.1540-8167.2006.00491.x
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发表时间：
2006-07-01
影响因子：
2.7
通讯作者：
Ruskin, JN
中科院分区：
文献类型：
--
作者：
Mansour, M;Refaat, M;Ruskin, JN
背景：肺静脉电隔离（PVI）已成为症状性药物难治性房颤（AF）的主要治疗方法之一。在该手术期间，将消融损伤递送到左心房的某些区域可能在技术上具有挑战性。其中最具挑战性的区域是将左肺静脉（LPV）与左心耳（LAA）分开的脊，以及将右中肺静脉（RMPV）与右上级（RSPV）和右下（RIPV）肺静脉分开的脊。一个详细的解剖特征，这些地区还没有以前reported.Methods：磁共振血管造影（MRA）进行之前，接受肺静脉隔离的患者。本研究纳入了50例经MRA确定的RMPV连续患者。在另外30名没有RMPV的患者中检查了与左肺静脉相关的脊。腔内视图重建钆增强，屏气三维MRA数据集。结果：左心耳与左肺静脉分离的脊的宽度在其最西端为3.7 ± 1.1 mm。该脊的宽度为5 mm或更小的部分为16.6 +/- 6.4 mm长。发现RMPV与RSPV和RIPV之间的脊的宽度分别为3.0 +/- 1.5 mm和3.1 +/- 1.8 mm。有与无RMPV的患者LPV脊之间没有显着差异。结论：心房组织的脊的宽度分开LPV从LAA和RMPV从其邻近的静脉可以解释在这些地区获得稳定的导管位置的技术挑战。对这些区域的解剖结构进行详细评估可能会提高这些部位导管消融的安全性和有效性。
Background: Pulmonary vein isolation (PVI) has become one of the primary treatments for symptomatic drug-refractory atrial fibrillation (AF). During this procedure, delivery of ablation lesions to certain regions of the left atrium can be technically challenging. Among the most challenging regions are the ridges separating the left pulmonary veins (LPV) from the left atrial appendage (LAA), and the right middle pulmonary vein (RMPV) from the right superior (RSPV) and right inferior (RIPV) pulmonary veins. A detailed anatomical characterization of these regions has not been previously reported.Methods: Magnetic resonance angiography (MRA) was performed in patients prior to undergoing PVI. Fifty consecutive patients with a RMPV identified by MRA were included in this study. Ridges associated with the left pulmonary veins were examined in an additional 30 patients who did not have a RMPV. Endoluminal views were reconstructed from the gadolinium-enhanced, breath-hold three-dimensional MRA data sets. Measurements were performed using electronic calipers.Results: The width of the ridge separating the LPV from the LAA was found to be 3.7 +/- 1.1 mm at its narrowest point. The segment of this ridge with a width of 5 mm or less was 16.6 +/- 6.4 mm long. The width of the ridges separating the RMPV from the RSPV and the RIPV was found to be 3.0 +/- 1.5 mm and 3.1 +/- 1.8 mm, respectively. There were no significant differences between LPV ridges for patients with versus without a RMPV.Conclusion: The width of the ridges of atrial tissue separating LPV from the LAA and the RMPV from its neighboring veins may explain the technical challenge in obtaining stable catheter positions in these areas. A detailed assessment of the anatomy of these regions may improve the safety and efficacy of catheter ablation at these sites.