Three-dimensional analysis of pulmonary venous ostial and antral anatomy: Implications for balloon catheter-based pulmonary vein isolation

Jameel Ahmed, Sandeep Sohal, Zachary J. Malchano, Godtfred Holmvang, Jeremy N. Ruskin, Vivek Y. Reddy

Research output: Contribution to journalArticlepeer-review

65 Scopus citations

Abstract

Background: Balloon ablation catheters using various energy sources are being developed to perform pulmonary vein (PV) isolation to treat atrial fibrillation. Prior evaluations of 2D CT/MR images are limited by the frequent elliptical shape of the PV ostia, the nonorthogonal orientation of the PVs to the left atrial (LA) chamber, and difficulty in appreciating through-slice curvature. To provide anatomical data relevant to balloon catheter ablation, 3D surface reconstructions of LA-PVs were generated and analyzed to define ostial architecture and size. Methods and Results: Using MRI datasets obtained from 101 paroxysmal AF patients, the LA-PVs were segmented to generate 3D LA-PV surface reconstructions. Using both external and endoluminal projections, the PV ostial and antral regions were identified and evaluated. In the left PVs, a common left-sided ostium was identified in 94 patients, with an ostial circumference of 95 ± 15 mm. Branching of the left PVs occurred 0-5 mm away from the common left ostium in 43 patients (43%), 5-15 mm away from the common os in 37 patients (37%), and >15 mm away from the common os in 14 patients (14%). In patients with either distinct left PV ostia, or common os <15 mm (87 patients), the individual LSPV/LIPV ostial circumferences were 67 ± 12 mm and 58 ± 9 mm, respectively. Mean left antral circumference was 114 ± 17 mm. In the right PVs, the ostial circumferences of the RSPV/RIPV were 68 ± 11 mm and 66 ± 11 mm, respectively. Mean right antral circumference was 107 ± 19 mm. Assuming ideal deformation of the LA chamber anatomy, the minimal diameters of a balloon ablation catheter required to isolate 95% of the RSPV, RIPV, LSPV, LIPV, LCPV, left antrum, and right antrum are 29 mm, 28 mm, 29 mm, 24 mm, 40 mm, 46 mm, and 47 mm, respectively. Conclusion: Analysis of 3D surface reconstructions of LA-PV anatomy reveals that balloon catheter-based ablation of the PVs is likely feasible in most patients, but balloon ablation of the common PV antra would be problematic.

Original languageEnglish
Pages (from-to)251-255
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

Keywords

  • Ablation
  • Atrial fibrillation
  • Balloon catheter
  • Electrophysiology
  • Left atrium
  • Magnetic resonance imaging
  • Pulmonary veins

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