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. 2018 Jul 13;18(1):146.
doi: 10.1186/s12872-018-0884-3.

Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation

M Skowerski  1 , I Wozniak-Skowerska  2 , A Hoffmann  2 , S Nowak  2 , T Skowerski  3 , M Sosnowski  4 , A M Wnuk-Wojnar  2 , K Mizia-Stec  2
Affiliations

Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation

M Skowerski et al. BMC Cardiovasc Disord. .

Abstract

Background: It has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation. The aim of the study was to assess anatomy abnormalities of the PV and LA in the patients with the history of AF and compare it with the control group(CG).

Methods: The multi-slice tomography (MSCT) scans were performed in 224 AF pts. before PVI (129 males, mean age 59 ± 9 yrs). The CG consisted of 40 pts. without AF (26 males, age 45 ± 9 yrs). LA and PV anatomy were evaluated. Diameters of PV ostia were measured in two directions: anterior-posterior (AP) and superior-inferior (SI) automatically using Vitrea 4.0.

Results: Pulmonary veins anatomy variants were observed more frequently in the atrial fibrillation group - 83 pts. (37%) vs 6 pts. (15%) in CG; 9% (21 pts) left common ostia (CO), 2% (5 pts) right CO, 19% (42 pts) additional right PV (APV), (1.8%) 4 pts. APV left, 8% right early branching (EB) and 3.5% left EB. The LA diameter differed significantly in AF vs CG group (41.2 ± 6 mm vs 35 ± 4.2 mm, p < 0.0001) respectively.

Conclusions: The anomalies of pulmonary vein anatomy occurred more often in pts. with AF. They can be defined as an image biomarkers of atrial fibrillation. Right additional (middle) pulmonary vein was the most important anomaly detected in AF patients as well as enlargered diameters of the LA and PV ostia.

Keywords: Atrial fibrillation; CT angiography; Pulmonary vein isolation.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the ethics committee (Medical University of Silesia ethics comittee) and conformed to the Declaration of Helsinki. An informed written consent was obtained from every patient enrolled in the study.

Consent for publication

n/a

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Computed tomography scan with three-dimensional reconstruction of pulmonary veins and the left atrium. The arrow indicates an additional pulmonary vein
Fig. 2
Fig. 2
Three-dimensional reconstruction of pulmonary veins and left atrium. Arrow indicates a common truncus of the left pulmonary vein
Fig. 3
Fig. 3
Left common ostia with right additional PV (middle PV)
Fig. 4
Fig. 4
Abnormality of PV localization: all (4) PVs left were close to each other on the posterior wall of LA
See this image and copyright information in PMC

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