Multidetector computed tomography in planning the treatment of atrial fibrillation

• Published in: Radiologia Vol. 62; no. 2; pp. 148 - 159
• Main Authors: Angulo Hervias, E, Guillén Subirán, M E, Yagüe Romeo, D, Castán Senar, A, Seral Moral, P, Núñez Motilva, M E
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-03-2020
• Subjects: Adult; Aged; Atrial Fibrillation - surgery; Female; Heart Atria - anatomy & histology; Heart Atria - diagnostic imaging; Heart Diseases - diagnostic imaging; Humans; Male; Middle Aged; Multidetector Computed Tomography; Preoperative Period; Pulmonary Veins - anatomy & histology; Pulmonary Veins - diagnostic imaging; Thrombosis - diagnostic imaging; Diámetro ostial; Pulmonary veins; Tomografía computarizada multidetector; Atrial fibrillation; Ostial diameter; Venas pulmonares; Fibrilación auricular; Orejuela izquierda; Multidetector computed tomography
• DOI: 10.1016/j.rx.2019.07.002
• EISSN: 1578-178X; 2173-5107

To know the anatomy of the pulmonary veins (PVs) by multidetector computed tomography (MDCT) in patients with atrial fibrillation (AF) prior to ablation.
MDCT was performed in 89 patients with AF, analyzing the number of PVs, accessory variants and veins, diameter and ostial shape, distance to the first bifurcation and thrombus in the left atrial appendage.
The most frequent venous pattern was 4 PVs (two right and two. left) in 49 patients (55.1%). The superior veins had a statistically significant greater mean ostial diameter than the inferior veins (Right Superior Pulmonary Vein (RSPV)> Right Inferior Pulmonary Vein (RIPV); p=0.001 and Left Superior Pulmonary Vein (LSPV)> Left Inferior Pulmonary Vein (LIPV); p<0.001). The right pulmonary veins ostial diameters were significantly larger than the left pulmonary veins ostial diameters (RSPV> LSPV; p<0.001 and RIPV> LIPV; p<0.001). The most circular ostium was presented by the VPID (ratio: 0.885) compared to the LIPV (p<00.1) and LSPV (p<0.001). The superior veins had a statistically significant greater mean distance to first bifurcation than the inferior veins (RSPV> RIPV; p=0.008 and LSPV> LIPV; p=0.038). Mean distance to first bifurcation has been greater in left PVs respect to the right PVs (LSPV> RSPV; p<0.001and LIPV> RIPV; p<0.001). Other findings found in AI: diverticula (30), accessory auricular appendages (5), septal aneurysms (8), septal bags (6) and 1 thrombus in the left atrial appendage.
MDCT prior to ablation demonstrates the anatomy of the left atrium (LA) and pulmonary veins with significant differences between the diameters and morphology of the venous ostia.