Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography
Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography
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DOI：
10.1046/j.1540-8167.2003.02444.x
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发表时间：
2003-02-01
影响因子：
2.7
通讯作者：
Oral, H
中科院分区：
文献类型：
--
作者：
Scharf, C;Sneider, M;Oral, H
肺静脉解剖学。简介：肺静脉 (PV) 的解剖排列是可变的。先前没有研究定量分析节段性孔口消融对 PV 的影响。本研究的目的是确定节段性孔口射频消融对心房颤动 (AF) 患者 PV 解剖结构的影响。方法和结果：根据 58 名接受节段性孔口射频消融术分离 PV 的 AF 患者和 10 名无 AF 病史的对照受试者的计算机断层扫描 (CT) 扫描，构建了 PV 的三维模型。大约 4 个月后重复进行 CT 扫描。 PV 和左心房尺寸用数字卡尺测量。 47 名受试者存在四个独立的 PV 口； 2 名受试者存在 3 个孔口； 9 名受试者中有 5 个孔口。上位 PV 具有比下位 PV 更大的孔口。与对照组相比，房颤患者的 PV 口之间的左心房面积更大，开口直径也更大。节段性孔口消融导致孔口直径缩小 1.5 +/- 3.2 mm。在 128 个孤立的 PV 中，有 3% 的患者距口 7.6 +/- 2.2 mm 处存在 28% 至 61% 的局灶性狭窄。在平均 245 105 天的随访期间，没有出现有症状的 PV 狭窄。结论：PV 的 CT 可以在导管消融手术之前识别解剖变异。节段性孔口消融导致孔口直径显着但小幅减小。局灶性狭窄很少发生，可归因于 PV 内射频能量的传递。
Pulmonary Vein Anatomy. Introduction: The anatomic arrangement of pulmonary veins (PVs) is variable. No prior studies have quantitatively analyzed the effects of segmental ostial ablation on the PVs. The aim of this study was to determine the effect of segmental ostial radiofrequency ablation on PV anatomy in patients with atrial fibrillation (AF).Methods and Results: Three-dimensional models of the PVs were constructed from computed tomographic (CT) scans in 58 patients with AF undergoing segmental ostial ablation to isolate the PVs and in 10 control subjects without a history of AF. CT scans were repeated approximately 4 months later. PV and left atrial dimensions were measured with digital calipers. Four separate PV ostia were present in 47 subjects; 3 ostia were present in 2 subjects; and 5 ostia were present in 9 subjects. The superior PVs had a larger ostium than the inferior PVs. Patients with AF had a larger left atrial area between the PV ostia and larger ostial diameters than the controls. Segmental ostial ablation resulted in a 1.5 +/- 3.2 mm narrowing of the ostial diameter. A 28% to 61% focal stenosis was present 7.6 +/- 2.2 mm from the ostium in 3% of 128 isolated PVs. There were no instances of symptomatic PV stenosis during a mean follow-up of 245 105 days.Conclusion: CT of the PVs allows identification of anatomic variants prior to catheter ablation procedures. Segmental ostial ablation results in a significant but small reduction in ostial diameter. Focal stenosis occurs infrequently and is attributable to delivery of radiofrequency energy within the PV.