Three-dimensional reconstruction of pulmonary veins and left atrium. Implications for catheter ablation of atrial fibrillation

• Published in: Herz Vol. 28; no. 7; pp. 559 - 565
• Main Authors: Ernst, Sabine, Broemel, Thomas, Krumsdorf, Ulrike, Hachiya, Hitoshi, Ouyang, Feifan, Linder, Christian, Falk, Peter, Bänsch, Dietmar, Schaumann, Anselm, Kuck, Karl-Heinz, Antz, Matthias
• Format: Journal Article
• Language: German
• Published: Germany 01.11.2003
• Subjects: Aged; Atrial Fibrillation - surgery; Catheter Ablation; Contrast Media; Electrocardiography; Female; Forecasting; Heart Atria - anatomy & histology; Humans; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Pulmonary Veins - anatomy & histology; Software; Tomography, Spiral Computed
• ISSN: 0340-9937
• DOI: 10.1007/s00059-003-2496-6

Selective pulmonary vein (PV) isolation to eliminate triggers is commonly used for curative catheter ablation of atrial fibrillation guided by two-dimensional (2-D) PV angiography, which is somewhat limited to depict the complex morphology of the PVs. 3-D mapping systems are limited to reconstruct the complete "true" anatomy by the reach of the mapping electrode related to catheter properties (maximum deflection and curve). New 3-D imaging systems (spiral computed tomography [CT] or magnetic resonance imaging [MRI]) provide detailed knowledge of the individual left atrial and PV morphology. Especially with the tampering, funnel-shaped PV ostia, identification of the PV ostium in selective PV isolation procedures aiming at the interruption of myocardial fibers is rather challenging using the 2-D imaging technique of contrast angiography. In a total of 16 patients (13 male, three female, mean age 57 +/- 8 years), cardiac 3-D magnetic resonance angiography (MRA; 1.5 T, ACS Intera Philips, Germany) using an ECG-gated technique (1.3-1.7 mm slices) was performed. Using the postprocessing software Leonardo (Siemens, Germany), all adjacent anatomic structures such as the pulmonary artery were cut off to focus on the left atrium (LA) and PV anatomy. Left-sided PVs always entered in close proximity into the LA (common ostium in two patients). The right PVs entered more separately into the LA with a predominance of oval shapes. MRA is a noninvasive tool providing knowledge of the individual 3-D anatomy in a photorealistic fashion. Ultimately, image fusion with 3-D mappings systems would allow for true 3-D electrophysiologic mapping and could facilitate further understanding of the underlying substrate of so far "unsolved" complex arrhythmias such as atrial fibrillation in the future.