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JACC. Clinical Electrophysiology Apr 2023
Topics: Humans; Pulmonary Veins; Atrial Fibrillation; Catheter Ablation
PubMed: 37100533
DOI: 10.1016/j.jacep.2022.12.026 -
International Journal of Cardiology Apr 2023Cardiovascular magnetic resonance (CMR) imaging allows to combine pulmonary perfusion measurements and pulmonary venous angiography during a single-session examination...
BACKGROUND
Cardiovascular magnetic resonance (CMR) imaging allows to combine pulmonary perfusion measurements and pulmonary venous angiography during a single-session examination with both imaging modules representing the basis for accurate diagnosis and therapeutic stratification of pulmonary vein (PV) stenosis. The present study investigated the clinical utility of dynamic pulmonary perfusion imaging integrated into a comprehensive CMR protocol for the evaluation of patients with suspected PV stenosis.
METHODS
162 patients with clinically suspected PV stenosis after catheter ablation of atrial fibrillation underwent a combined single-session CMR examination (cardiac cine imaging, dynamic pulmonary perfusion, and three-dimensional PV angiography). CMR angiography was used for visual grading of PV stenoses; dynamic pulmonary perfusion imaging was evaluated per lung lobe visually and quantitatively.
RESULTS
All PV stenosis ≥90% showed a visible perfusion deficit of the corresponding lung lobe (60/60, 100%) while all PVs with luminal narrowing <50% exhibited normal pulmonary perfusion (680/680, 100%). However, every third 70-89% stenosis showed a normal pulmonary perfusion (10/31, 32%) while every fourth 50-69% PV stenosis was associated with hypoperfusion of the corresponding lung lobe (9/39, 23%). For quantitative pulmonary perfusion measurements, ROC analysis demonstrated high discriminatory power regarding PV stenosis detection with the highest AUC values for time-to-peak enhancement (cut-off value, 8.5 s).
CONCLUSIONS
The combination of CMR angiography and CMR pulmonary perfusion allowed for assessment of the anatomical degree of PV stenosis and its hemodynamic impact on the pulmonary parenchymal level. Thus, the proposed comprehensive CMR protocol provided an efficient diagnostic work-up of patients with suspected PV stenosis.
Topics: Humans; Stenosis, Pulmonary Vein; Constriction, Pathologic; Pulmonary Veins; Atrial Fibrillation; Magnetic Resonance Angiography; Catheter Ablation; Lung; Perfusion; Magnetic Resonance Spectroscopy
PubMed: 36791965
DOI: 10.1016/j.ijcard.2023.02.011 -
Future Cardiology Sep 2022Determining the optimal prescribing and stopping points for diuretic therapy remains a challenge in outpatients who have heart failure with preserved ejection fraction....
Determining the optimal prescribing and stopping points for diuretic therapy remains a challenge in outpatients who have heart failure with preserved ejection fraction. The aim was to study pulmonary vein diameters for prescribing diuretic therapy and estimating its effectiveness in outpatients with heart failure with preserved ejection fraction. Patients with heart failure with preserved ejection fraction were examined before and after 6 months of standard heart failure therapy, including loop diuretics. The maximum and minimum diameters of pulmonary veins were estimated by echocardiography. A decrease in the maximum and minimum diameters of the pulmonary vein and the left atrial volume was detected after treatment. Increases in pulmonary vein diameters and left atrial volumes in the absence of symptoms and signs of heart failure were detected after withdrawing diuretic therapy; this caused its resumption in a maintenance dose. Pulmonary vein diameters can be used for prescribing diuretic therapy and estimating its effectiveness in outpatients with heart failure with preserved ejection fraction.
Topics: Diuretics; Heart Failure; Humans; Outpatients; Pulmonary Veins; Stroke Volume; Ventricular Function, Left
PubMed: 35815852
DOI: 10.2217/fca-2021-0066 -
European Heart Journal. Cardiovascular... Mar 2022Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However,...
AIMS
Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However, no data are available on the impact of PV orientation on the long-term success rates of point-by-point PVI. We sought to determine the impact of PV anatomy and orientation on atrial fibrillation (AF)-free survival in patients undergoing PVI using the radiofrequency point-by-point technique.
METHODS AND RESULTS
We retrospectively included 448 patients who underwent initial point-by-point radiofrequency ablation for AF at our department. Left atrial computed tomography angiography was performed before each procedure. PV anatomical variations, ostial parameters (area, effective diameter, and eccentricity), orientation, and their associations with 24-month AF-free survival were analysed. PV anatomical variations and ostial parameters were not predictive for AF-free survival (all P > 0.05). Univariate analysis showed that female sex (P = 0.025) was associated with higher rates of AF recurrence, ventral-caudal (P = 0.002), dorsal-cranial (P = 0.034), and dorsal-caudal (P = 0.042) orientation of the right superior PV (RSPV), on the other hand, showed an association with lower rates of AF recurrence, when compared with the reference ventral-cranial orientation. On multivariate analysis, both female sex [odds ratio (OR) 1.83, 95% CI 1.15-2.93, P = 0.011] and ventral-caudal RSPV orientation, compared with ventral-cranial orientation, proved to be independent predictors of 24-month AF recurrence (OR 0.37, 95% CI 0.19-0.71, P = 0.003).
CONCLUSION
Female sex and ventral-caudal RSPV orientation have an impact on long-term arrhythmia-free survival. Assessment of PV orientation may be a useful tool in predicting AF-free survival and may contribute to a more personalized management of AF.
Topics: Atrial Fibrillation; Catheter Ablation; Female; Humans; Pulmonary Veins; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 33693618
DOI: 10.1093/ehjci/jeab041 -
Methodist DeBakey Cardiovascular Journal Apr 2021Catheter ablation has become a cornerstone treatment for atrial fibrillation (AF). Pulmonary vein isolation is the accepted approach for paroxysmal AF ablation, but it... (Review)
Review
Catheter ablation has become a cornerstone treatment for atrial fibrillation (AF). Pulmonary vein isolation is the accepted approach for paroxysmal AF ablation, but it is less effective for persistent AF. The vein of Marshall (VOM) is located in the epicardial left atrium and can be a source of AF triggers as well as a tract for autonomic nerves. It directly communicates with the underlying myocardium, including the left atrial ridge and the posterior mitral isthmus. This review discusses the latest evidence regarding the mechanisms, procedural aspects, and outcomes of VOM ethanol infusion when used as an adjunct to pulmonary vein isolation in patients with persistent AF.
Topics: Ablation Techniques; Action Potentials; Animals; Atrial Fibrillation; Coronary Vessels; Ethanol; Heart Rate; Humans; Infusions, Intravenous; Pulmonary Veins
PubMed: 34104321
DOI: 10.14797/ZQME8581 -
JAMA Sep 2023
Topics: Mental Health; Pulmonary Veins; Atrial Fibrillation; Humans
PubMed: 37698577
DOI: 10.1001/jama.2023.6484 -
Journal of Cardiovascular... Jun 2021The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome. The novel...
BACKGROUND
The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome. The novel fourth-generation cryoballoon (CB4) incorporates a 40% shorter distal tip. This design change may translate into an increased rate of PVI real-time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE).
METHODS AND RESULTS
Three hundred consecutive patients with paroxysmal or persistent atrial fibrillation were prospectively enrolled. The first 150 consecutive patients underwent CB2 based PVI (CB2 group) and the last 150 consecutive patients were treated with the CB4 (CB4 group). A total of 594/594 (100%, CB4) and 589/594 (99.2%, CB2) pulmonary veins (PVs) were successfully isolated utilizing the CB4 and CB2, respectively (p = .283). The real-time PVI visualization rate was 47% (CB4) and 39% (CB2; p = .005) and the mean freeze cycle duration 200 ± 90 s (CB4) and 228 ± 110 s (CB2; p < .001), respectively. The total procedure time did not differ between the groups (CB4: 64 ± 32 min) and (CB2: 62 ± 29 min, p = .370). No differences in periprocedural complications were detected.
CONCLUSIONS
A higher rate of real-time electrical PV recordings are seen using the CB4 as compared to CB2, which may facilitate an individualized ablation strategy using the TTE.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 33760304
DOI: 10.1111/jce.15009 -
The Journal of Thoracic and... Jun 2024
Topics: Humans; Atrial Fibrillation; Pulmonary Veins; Catheter Ablation; Treatment Outcome
PubMed: 37030474
DOI: 10.1016/j.jtcvs.2023.03.024 -
Journal of Anatomy Jan 2024The left atrium wall has several origins, including the body, appendage, septum, atrial-ventricular canal, posterior wall, and venous component. Here, we describe the...
The left atrium wall has several origins, including the body, appendage, septum, atrial-ventricular canal, posterior wall, and venous component. Here, we describe the morphogenesis of left atrium based on high-resolution imaging (phase-contrast X-ray computed tomography and magnetic resonance imaging). Twenty-three human embryos and 19 fetuses were selected for this study. Three-dimensional cardiac images were reconstructed, and the pulmonary veins and left atrium, including the left atrial appendage, were evaluated morphologically and quantitatively. The positions of the pericardial reflections were used as landmarks for the border of the pericardial cavity. The common pulmonary vein was observed in three specimens at Carnegie stages 17-18. The pericardium was detected at the four pulmonary veins (left superior, left inferior, right superior, and right inferior pulmonary veins) at one specimen at Carnegie stage 18 and all larger specimens, except the four samples. Our results suggest that the position of the pericardial reflections was determined at two pulmonary veins (right and left pulmonary vein) and four pulmonary veins almost simultaneously when the dorsal mesocardial connection between the embryo and heart regressed. The magnetic resonance images and reconstructed heart cavity images confirmed that the left atrium folds were present at the junction between the body and venous component. Three-dimensional reconstruction showed that the four pulmonary veins entered the dorsal left atrium tangentially from the lateral to the medial direction. More specifically, the right pulmonary veins entered at a greater angle than the left pulmonary veins. The distance between the superior and inferior pulmonary veins was shorter than that between the left and right pulmonary veins. Three-dimensional reconstruction showed that the venous component increased proportionally with growth. No noticeable differences in discrimination between the right and left parts of the venous component emerged, while the junction between the venous component and body gradually became inconspicuous but was still recognizable by the end of the observed early fetal period. The left superior pulmonary vein had the smallest cross-sectional area and most flattened shape, whereas the other three were similar in area and shape. The left atrial appendage had a large volume in the center and extended to the periphery as a lobe-like structure. The left atrial appendage orifice increased in the area and tended to become flatter with growth. The whole left atrium volume^(1/3) increased almost proportionally with growth, parallel to the whole heart volume. This study provided a three-dimensional and quantitative description of the developmental process of the left atrium, comprising the venous component and left atrial appendage formation, from the late embryonic to the early fetal stages.
Topics: Humans; Pulmonary Veins; Atrial Appendage; Heart Atria; Fetus; Morphogenesis
PubMed: 37559438
DOI: 10.1111/joa.13941 -
Journal of Cardiovascular... Jul 2020There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and...
INTRODUCTION
There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation.
METHODS AND RESULTS
Patients with paroxysmal atrial fibrillation treated with VGLB were screened. Study participants underwent contrast-enhanced computed tomography (CT) scanning before and 6 months after the procedure. We defined 25% to 49%, 50% to 74%, and 75% to 100% reduction in PV cross-sectional area as mild, moderate, and severe narrowing, respectively. Of 146 PVs in 38 patients analyzed, severe narrowing developed in two right superior and one right inferior PV. Moderate or severe narrowing occurred in 40 veins (27% of all PVs, 50% of the right superior, 22% of the right inferior, 21% of the left superior, and 14% of the left inferior PV). In PVs with moderate-severe narrowing, the baseline orifice area was significantly larger (4.1 [interquartile range, 3.2-4.8] vs 2.5 [1.9-3.3] cm , P < .0001), the narrowest region of stenosis was significantly more distal into the vessel (1.9 [0.7-2.9] vs 0 [0-1.7] mm from the orifice, P = .0006) and the total amount of energy delivered per vein was significantly greater (5190 ± 970 vs 4626 ± 1573 J, P = .018) than in PVs with mild or no significant narrowing. The baseline orifice area independently predicted moderate-severe narrowing in multivariate analysis (odds ratio, 1.8 [1.3-2.5] per 1 cm increase, P = .0003). No patient exhibited any signs or symptoms of PV stenosis.
CONCLUSIONS
Baseline PV orifice area, ablating distally inside the veins, and total amount of laser energy are associated with PV narrowing after VGLB ablation.
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Laser Therapy; Odds Ratio; Pulmonary Veins; Stenosis, Pulmonary Vein; Treatment Outcome
PubMed: 32367545
DOI: 10.1111/jce.14525