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Clinical Cardiology Nov 2021Left atrial appendage (LAA) is a potential source of atrial fibrillation (AF) triggers.
Cardiac computed tomography angiography-derived analysis of left atrial appendage morphology and left atrial dimensions for the prediction of atrial fibrillation recurrence after pulmonary vein isolation.
BACKGROUND
Left atrial appendage (LAA) is a potential source of atrial fibrillation (AF) triggers.
HYPOTHESIS
LAA morphology and dimensions are associated with AF recurrence after pulmonary vein isolation (PVI).
METHODS
From cardiac computed tomography angiography (CCTA), left atrial (LA), pulmonary vein (PV), and LAA anatomy were assessed in cryoballoon ablation (CBA) patients.
RESULTS
Among 1103 patients undergoing second-generation CBA, 725 (65.7%) received CCTA with 473 (42.9%) qualifying for detailed LAA analysis (66.3 ± 9.5 years). Symptomatic AF reoccurred in 166 (35.1%) patients during a median follow-up of 19 months. Independent predictors of recurrence were LA volume, female sex, and mitral regurgitation ≥°II. LAA volume and AF-type were dependent predictors of recurrence due to their strong correlations with LA volume. LA volumes ≥122.7 ml (sensitivity 0.53, specificity 0.69, area under the curve [AUC] 0.63) and LAA volumes ≥11.25 ml (sensitivity 0.39, specificity 0.79, AUC 0.59) were associated with recurrence. LA volume was significantly smaller in females. LAA volumes showed no sex-specific difference. LAA morphology, classified as windsock (51.4%), chicken-wing (20.7%), cactus (12.5%), and cauliflower-type (15.2%), did not predict successful PVI (log-rank; p = 0.596).
CONCLUSIONS
LAA volume was strongly correlated to LA volume and was a dependent predictor of recurrence after CBA. Main independent predictors were LA volume, female sex, and mitral regurgitation ≥°II. Gender differences in LA volumes were observed. Individual LAA morphology was not associated with AF recurrence after cryo-PVI. Our results indicate that preprocedural CCTA might be a useful imaging modality to evaluate ablation strategies for patients with recurrences despite successful PVI.
Topics: Atrial Appendage; Atrial Fibrillation; Catheter Ablation; Computed Tomography Angiography; Female; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 34651337
DOI: 10.1002/clc.23743 -
Journal of Magnetic Resonance Imaging :... Apr 2013To compare pulmonary vein and left atrial anatomy using three-dimensional free-breathing whole-heart magnetic resonance imaging (MR) at 3 Tesla (T) and multi-detector... (Comparative Study)
Comparative Study
PURPOSE
To compare pulmonary vein and left atrial anatomy using three-dimensional free-breathing whole-heart magnetic resonance imaging (MR) at 3 Tesla (T) and multi-detector computed tomography (MDCT).
MATERIALS AND METHODS
Thirty-three subjects (19 male, age 49 ± 12 years) underwent free-breathing 3T MR and contrast-enhanced MDCT during inspiratory breath hold. Pulmonary vein parameters (ostial areas, diameters, angles) were measured.
RESULTS
All pulmonary veins and anomalies were identified by 3T MR and by MDCT. The right-sided pulmonary veins were directed more posteriorly, the right superior pulmonary vein more inferiorly, and the right inferior pulmonary vein more superiorly by 3T MR when compared with MDCT. The cross-sectional area, perimeters and minimum diameters of right-sided pulmonary vein ostia were significantly larger by MR, as were the maximum diameters of right and left inferior pulmonary veins. There were no significant differences between techniques in distance to first pulmonary vein branch.
CONCLUSION
Pulmonary vein measurements demonstrated significant differences in angulations and dimensions when 3T MR is compared with MDCT. These differences likely represent hemodynamic and respiratory variation during free-breathing with MR versus breath-holding with MDCT. MR imaging at 3T during free-breathing offers an alternate method to define pulmonary vein and left atrial anatomy without exposure to radiation.
Topics: Adult; Aged; Breath Holding; Female; Heart Atria; Hemodynamics; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Multidetector Computed Tomography; Pulmonary Veins; Respiratory-Gated Imaging Techniques; Sensitivity and Specificity
PubMed: 23172711
DOI: 10.1002/jmri.23865 -
Journal of Cardiothoracic Surgery Apr 2023Although the pressure of pulmonary vein increases before pulmonary artery in pulmonary hypertension due to left heart disease (PH-LHD), only a few studies have assessed...
BACKGROUND
Although the pressure of pulmonary vein increases before pulmonary artery in pulmonary hypertension due to left heart disease (PH-LHD), only a few studies have assessed pulmonary vein smooth muscle cells (PVSMCs) because of the lack of a simple and feasible isolation method.
METHODS
In this study, we introduced a simple method to obtain PVSMCs. Primary pulmonary veins were removed by puncture needle cannula guidance. Then, PVSMCs were cultured by the tissue explant method and purified by the differential adhesion method. The cells were characterized by hematoxylin-eosin (HE) staining, immunohistochemistry, western blotting, and immunofluorescence to observe the morphology and verify the expression of alpha-smooth muscle actin (α-SMA).
RESULTS
The HE staining results showed that the pulmonary vein media was thinner than the pulmonary artery, the intima and adventitia of the pulmonary vein were removed by this method, and the obtained cells with good activity exhibited morphological characteristics of smooth muscle cells. In addition, higher α-SMA expression was observed in the cells obtained by our isolation method than in the traditional method.
CONCLUSION
This study established a simple and feasible method to isolate and culture PVSMCs that might facilitate the cytological experiments for PH-LHD.
Topics: Rats; Animals; Pulmonary Veins; Hypertension, Pulmonary; Myocytes, Smooth Muscle; Pulmonary Artery; Immunohistochemistry; Cells, Cultured
PubMed: 37069582
DOI: 10.1186/s13019-023-02233-1 -
Medicine Oct 2022Partial anomalous pulmonary venous connection is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation leading to left...
RATIONALE
Partial anomalous pulmonary venous connection is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation leading to left to right heart shunt. Although correction of anomalous pulmonary venous connection is achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connection to both left atrium and the major systemic veins. Under these circumstances, catheter-based treatment might become a feasible option.
PATIENT CONCERNS
A 22-year-old female presented with exertional dyspnea, holo-systolic murmur in left sternal border, and fixed splitting of S2 in examination.
DIAGNOSIS
The patient was diagnosed with secundum type atrial septal defect (ASD) and dual drainage of left upper pulmonary vein.
INTERVENTIONS
The patient was candidate for device closure. Under TEE guidance, occluder devices were deployed in the upper part of vertical vein and subsequently in place of ASD.
OUTCOMES
Echocardiogram in the next day showed complete occlusion of flow through the vertical vein and ASD. Dual antiplatelet was prescribed on discharge. Follow-up echocardiography after 3 months showed obvious improvement in RV size. Due to suspicion for clot formation, TEE was done and thrombosis with approximate length of extension of 15 mm was detected back to the device. The patient is following for 5 years. Repeated TEE after 2 years did not show any change in the burden of clot.
LESSONS
For comprehensive evaluation of patients with ASD, assessment of pulmonic veins is crucial and in the presence of a vertical vein, the dual drainage of pulmonic veins should be considered.
Topics: Female; Humans; Young Adult; Adult; Pulmonary Veins; Heart Septal Defects, Atrial; Scimitar Syndrome; Heart Atria; Catheters
PubMed: 36281198
DOI: 10.1097/MD.0000000000031011 -
Journal of the American College of... Aug 2017
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins; Radiofrequency Ablation; Temperature
PubMed: 28750698
DOI: 10.1016/j.jacc.2017.06.009 -
Journal of the American Heart... Mar 2018The reported incidence of phrenic nerve injury (PNI) varies owing to different definitions, balloon generations, balloon size, freezing regimen, and protective... (Observational Study)
Observational Study
BACKGROUND
The reported incidence of phrenic nerve injury (PNI) varies owing to different definitions, balloon generations, balloon size, freezing regimen, and protective maneuvers. We evaluated the incidence, predictors, and outcome of PNI during cryoballoon pulmonary vein isolation in a large population.
METHODS AND RESULTS
Five hundred fifty atrial fibrillation patients underwent pulmonary vein isolation using one 28-mm second-generation cryoballoon and single 3-minute freeze strategy under diaphragmatic compound motor action potential (CMAP) monitoring. A total of 34 (6.2%) patients experienced PNI during the right superior and inferior pulmonary vein ablation in 30 and 4 patients, respectively. Applications were interrupted using double-stop techniques after 136 [104-158] second applications, and a pulmonary vein isolation was already achieved in all but one case. The baseline CMAP amplitude and timing of deflation (CMAP) were 0.75±0.30 and 0.17±0.17 mV, respectively. Persistent atrial fibrillation, larger right superior pulmonary vein ostia, and deeper balloon positions were associated with higher incidences of PNI. The CMAP predicted a PNI recovery delay, and the best cutoff value for predicting PNI recovery by the next day was 0.20 mV (sensitivity 57.1%, specificity 100%). Among 6 patients undergoing second procedures 8.5 (6.7-15.0) months later, the right superior pulmonary vein was durable in 3 with >120 second applications. Despite active balloon deflation, no significant pulmonary vein stenosis was observed in 15 right superior pulmonary veins evaluated 6 (5-9) months later. No patients had symptoms, and the PNI recovered 1 day and 1 month postprocedure in 21 and 4 patients, respectively.
CONCLUSIONS
PNI resulting from cryoballoon ablation was reversible. The double-stop technique is safe, and immediate active deflation following a CMAP decrease appears to be essential for faster PNI recovery.
Topics: Aged; Atrial Fibrillation; Cardiac Catheters; Catheter Ablation; Computed Tomography Angiography; Cryosurgery; Diaphragm; Equipment Design; Evoked Potentials, Motor; Female; Humans; Incidence; Japan; Male; Middle Aged; Operative Time; Peripheral Nerve Injuries; Phlebography; Phrenic Nerve; Pulmonary Veins; Risk Factors; Time Factors; Treatment Outcome
PubMed: 29574457
DOI: 10.1161/JAHA.117.008249 -
JACC. Clinical Electrophysiology Jun 2023
Topics: Humans; Hyperventilation; Pulmonary Veins; Respiration, Artificial
PubMed: 37380320
DOI: 10.1016/j.jacep.2023.04.029 -
Kardiologia Polska 2022
Topics: Angiography; Humans; Imaging, Three-Dimensional; Pulmonary Veins
PubMed: 34970983
DOI: 10.33963/KP.a2021.0197 -
American Journal of Physiology. Lung... May 2007The response of pulmonary arteries to endothelin-1 (ET-1) changes with age in normal pigs and is abnormal in pulmonary hypertension. The purpose of this study was to...
The response of pulmonary arteries to endothelin-1 (ET-1) changes with age in normal pigs and is abnormal in pulmonary hypertension. The purpose of this study was to determine if the same is true of the pulmonary veins. We studied the wall structure and functional response to ET-1 in pulmonary veins from normal pigs from fetal life to adulthood and from pigs subjected to chronic hypobaric hypoxia either from birth for 3 days or from 3 to 6 days of age. In isolated normal veins, the contractile response decreased by 40% between late fetal life and 14 days of age with a concomitant twofold increase in endothelium-dependent relaxant response. The ET(A) antagonist BQ-123 reduced the contractile response significantly more in newborn than older animals, whereas the ET-B antagonist BQ-788 had no effect in fetal animals and maximally increased contraction at 14 days of age. Hypoxic exposure significantly increased pulmonary vein smooth muscle area and contractile response to ET-1. The relaxation response was impaired following hypoxic exposure from birth but not from 3 to 6 days of age. The ET(A) antagonist BQ-123 decreased contractile and increased dilator responses significantly more than in age-matched controls. Thus pulmonary veins show age-related changes similar to those seen in the pulmonary arteries with a decrease in ET(A)-mediated contractile and increase in ET-B-mediated relaxant response with age. Contractile response was also increased in hypoxia as in the arteries. This study suggests that pulmonary veins are involved in postnatal adaptation and the pathogenesis of pulmonary hypertension.
Topics: Aging; Animals; Animals, Newborn; Disease Models, Animal; Endothelin-1; Fetus; Hypoxia; Muscle, Smooth, Vascular; Pulmonary Artery; Pulmonary Veins; Swine
PubMed: 17259291
DOI: 10.1152/ajplung.00173.2006 -
Radiologia 2017To analyze the usefulness of multidetector computed tomography (MDCT) in the preprocedural evaluation and follow-up of patients undergoing radiofrequency ablation of...
OBJECTIVE
To analyze the usefulness of multidetector computed tomography (MDCT) in the preprocedural evaluation and follow-up of patients undergoing radiofrequency ablation of pulmonary veins and the impact of the MDCT findings on the approach to treatment.
METHOD
We retrospectively analyzed 92 consecutive MDCT studies done in 80 patients between January 2011 and June 2013; 70 (76%) studies were done before a first ablation procedure and 22 (24%) were done in patients who had undergone an ablation procedure.
RESULTS
Findings were useful in 34% of the patients who underwent MDCT before the first ablation procedure and in 68% of the studies done after a procedure. The incidence of stroke associated with the ablation procedure was 3%, similar to the incidence recorded in our center before we started to use MDCT to evaluate the anatomy of the left atrium. All symptomatic patients had some pulmonary vein stenosis, and 80% had significant stenosis. Furthermore, the stenoses progressed very rapidly; treatment with balloon angioplasty was associated with early restenosis. Stenting was an alternative in cases of failed angioplasty.
CONCLUSION
In the preprocedural evaluation and postprocedural follow-up of patients undergoing pulmonary vein isolation, MDCT is useful for guiding treatment and detecting complications.
Topics: Atrial Fibrillation; Catheter Ablation; Female; Humans; Male; Middle Aged; Multidetector Computed Tomography; Postoperative Care; Preoperative Care; Pulmonary Veins; Retrospective Studies; Vascular Surgical Procedures
PubMed: 28457532
DOI: 10.1016/j.rx.2017.03.002