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. 2021 Aug;61(2):357-363.
doi: 10.1007/s10840-020-00817-8. Epub 2020 Jul 14.

Applicability of computed tomography preoperative assessment of the LAA in LV summit ablations

Marcin Kuniewicz  1   2 , M Krupiński  3 , M Gosnell  4 , K Budnicka  4 , N Jakob  4 , G Karkowski  5 , M Urbańczyk-Zawadzka  3 , J Lelakowski  5 , J Walocha  4
Affiliations

Applicability of computed tomography preoperative assessment of the LAA in LV summit ablations

Marcin Kuniewicz et al. J Interv Card Electrophysiol. 2021 Aug.

Abstract

Purpose: Ventricular arrhythmias originating from the left ventricular summit (LVS) may present with challenges for catheter ablation. Recently, the left atrial appendage (LAA) became a new vantage point for mapping and ablating arrhythmias from that region, but data of possible usefulness is limited.

Methods: From September to December 2019, we retrospectively analyzed 48 consecutive patient hearts (20 male; mean age 57.9y ± 11.56) undergoing diagnostic coronary vessel imaging in 64 dual-source computer tomography angiography (CTA). Distances from the LAA to the LVS, LAA shape type, and coronary arteries in the LVS region were measured. Also, we compared the true LVS area from CTA with a calculated formula derived from LVS definition.

Results: The mean LVS area calculated from the formula was 291.58 mm2 (± 115.5) while the true area calculated from CT was 263.33 mm2 (± 99.49) (p = 0.44). The mean inaccessible area was 133.42 mm2 (± 72.89), accessible 95.67 mm2 (± 72.77). The mean LAA coverage over LVS was 196.08 mm2-which is approximately 75% of LVS size in general. The most common LAA shape was chicken wing (50%); windsock has the highest accessible area coverage on average (80.23%), followed by chicken wing (59.88%), broccoli (47.72%), and cactus (46.98%). The mean distance from LAA to the surface was 5.14 mm (1.5 to 10 mm) and was not correlated with BMI. LAA has a 98% coverage over the point of transition between the great cardiac vein and anterior interventricular vein.

Conclusion: Angio-CT assessment of the LAA over the LVS structures may be helpful in decision making before an ablation procedure. LAA appears to be a promising mapping approach in LVS arrhythmias.

Keywords: Catheter ablation; Left atrial appendage; Left ventricular summit.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a LVS, green line; LMT left main trunk, LAA left atrial appendage, GCV great cardiac vein, SP septal perforator, LAD left anterior descending. Yellow line: Cx from bifurcation to right—proximal margin of LAA. Violet line: Cx from bifurcation to distal—left margin of LAA. Red asterisk: inaccessible area. Green asterisk: accessible area. Green circle over GCV: point of transition GCV–AIVV. b Distance from the LAA to the surface of the LVS
Fig. 2
Fig. 2
a Yamada equation for calculating the LVS area. LMT left main trunk, LAD left anterior descending, SP septal perforator, GCV great cardiac vein. b LVS with no accessible area. SP1 first septal perforator, Dx diagonal branches. c, d Overlap of right ventricular output tract (RVOT) and pulmonary trunk over LVS. PT pulmonary trunk, LMPA left main pulmonary artery, RMPA right main pulmonary artery, LAA left atrial appendage. e Clear LVS. f LVS with multiple coronary vessels
Fig. 3
Fig. 3
Four types of LAA. a Chicken wing. b Windsock. c Broccoli. d Cactus shape
Fig. 4
Fig. 4
Measurements of LAA coverage over LVS. a, b LVS without and with LAA. c, d Different example
See this image and copyright information in PMC

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