Simultaneous angiographic imaging of ipsilateral pulmonary veins for catheter ablation of atrial fibrillation

Abstract

Various imaging techniques are nowadays in clinical use to obtain important information about pulmonary vein (PV) anatomy in patients undergoing catheter ablation of atrial fibrillation (AF). Although some controversy exists about the optimal approach for catheter ablation of AF in recent times, knowledge of the individual left atrial-PV anatomy remains a basic feature of the different ablational techniques. Angiographic delineation of PV ostia has become an integral part of the PV isolation procedure, mainly in order to avoid potentially harmful PV stenosis. Selective venography with angiocatheters is well documented and widely available but has its own limitations, particularly with respect to visualization of the atriovenous junctions. The present report summarizes the usefulness, safety and feasibility of a new angiographic technique for simultaneous imaging of ipsilateral PVs applicable during catheter ablation of AF. Electrophysiologically guided segmental PV isolation was accomplished in 31 patients mostly with paroxysmal atrial fibrillation, who experienced significant clinical improvement during a followup of 17 +/- 15 months. The angiographic technique was effective for assessment of the individual anatomy including common ostia and supernumerary veins which can be easily missed by selective venography. Variant PV ostia were identified in about 20% of patients; particularly the presence of a left common trunk was challenging for the segmental ablation strategy. Angiographic detection of variant PV anatomy was comparable to visualization with computer tomography performed at 4-months follow-up. Finally, this type of angiographic imaging performed at the time of catheter ablation may help to reduce the risk of significant PV stenosis.