Determination of the spatial orientation and shape of pulmonary vein ostia by contrast-enhanced magnetic resonance angiography
Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
Pepijn H van der VoortAlbert Meijer
Abstract
For catheter ablation of atrial fibrillation (AF), proper catheter positioning is crucial and depends on knowledge of pulmonary vein (PV) anatomy. The aim of this study was to assess PV spatial orientation and ostial shape by contrast-enhanced magnetic resonance angiography (CE-MRA). In 30 consecutive AF patients, CE-MRA was performed prior to ostial ablation. Using a centre-line technique, the PV ostium was defined perpendicular to this centre-line. Minimal and maximal ostial diameters, ostial perimeter, and angles in the anatomical frontal and transverse planes were measured. Twenty-one patients had four separate PVs. In four patients, there was a distinct right-middle PV and in five a common left common PV was found. Left-sided PV ostia were smaller and more elliptical than right-sided PVs. In the transverse plane, the ostia of both superior PVs were directed anteriorly (LS -15 +/- 13 degrees , RS -13 +/- 11 degrees ) and both inferior PV ostia were directed posteriorly (LI 23 +/- 15 degrees , RI 39 +/- 15 degrees ). In the frontal plane, both superior PV ostia pointed upwards (LS -27 +/- 14 degrees , RS -33 +/- 12 degrees ) while the inferior ostia were directed horizontally (LI 2 +/- 11 degrees , RI 3 +/- 13 degrees ). PV ...Continue Reading
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