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Vol. 63. Issue 5.
Pages 391-399 (September - October 2021)
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Vol. 63. Issue 5.
Pages 391-399 (September - October 2021)
Original article
Anatomic characteristics of the left atrium in subjects undergoing radiofrequency ablation for atrial fibrillation
Características anatómicas de la aurícula izquierda en sujetos sometidos a ablación por radiofrecuencia de fibrilación auricular
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U. Martinez Urabayena, M. Caballerosb, I. Sorianoa, P. Ramosc, I. García Bolaoc, G. Bastarrikaa,
Corresponding author
bastarrika@unav.es

Corresponding author.
a Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
b Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Madrid, Spain
c Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Tables (4)
Table 1. Demographic data, cardiovascular risk factors and personal and family history of heart disease in the study population. Differences between men and women are compared.
Table 2. Diameters of the pulmonary veins and diameters and volumes of the left atrium in men and women. Differences between the sexes are compared.
Table 3. Differences in demographic characteristics, type of arrhythmia, cardiovascular risk factors and anatomical characteristics and diameters of the pulmonary veins and diameters and volume of the left atrium by ablation outcome. Outcomes between procedure success and arrhythmia recurrence following ablation are compared.
Table 4. Differences in the diameters of the pulmonary veins and diameters and volume of the left atrium following ablation.
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Abstract
Objective

To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence.

Material and methods

We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 ± 10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment.

Results

In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 ± 2.6 mm vs. 16.7 ± 2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 ± 2 mm vs. 13.8 ± 2.2 mm, p = 0.009) and larger left atrial volume (91.9 ± 24.9 cm3 vs. 70.7 ± 20.3 mm3, p = 0.001). After 22.1 ± 12.1 months’ mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 ± 23.0 mm3 vs. 71.1 ± 23.2 mm3, p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without.

Conclusion

The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.

Keywords:
Computed tomography
Pulmonary veins
Atrial fibrillation
Catheter ablation
Resumen
Objetivo

Definir las características anatómicas de la aurícula izquierda y las venas pulmonares (VP) en sujetos sometidos a ablación de fibrilación auricular (FA) e identificar posibles factores anatómicos relacionados con la recurrencia.

Material y métodos

Se estudiaron de manera retrospectiva los estudios de angio-TC de 95 pacientes (57 hombres, edad media 65 ± 10 años), realizados para planificación de ablación por radiofrecuencia de FA. Se revisó la anatomía de las VP y se recogieron los diámetros de sus ostium y los diámetros y volumen de la aurícula izquierda. Estos parámetros fueron comparados con el tipo de arritmia y la respuesta al tratamiento.

Resultados

La anatomía de las venas pulmonares fue normal (dos venas pulmonares derechas y dos izquierdas) en la mayoría de los pacientes (74,7%). Los pacientes con FA persistente presentaron diámetros ligeramente superiores de las venas pulmonares izquierdas (VPSI de 17,9 ± 2,6 mm vs. 16,7 ± 2,2 mm, p = 0,04; VPII de 15,3 ± 2 mm vs. 13,8 ± 2,2 mm, p = 0,009) y mayor volumen de la aurícula izquierda (91,9 ± 24,9 cm3 vs. 70,7 ± 20,3 mm3, p = 0,001) que los sujetos con FA paroxística. Tras un seguimiento medio de 22,1 ± 12,1 meses, el 43% de los pacientes presentaba ritmo sinusal. Los pacientes con recurrencia mostraron mayor volumen de la aurícula izquierda (81,4 ± 23 mm3 vs. 71,1 ± 23,2 mm3, p = 0,03). No se objetivaron diferencias significativas en los diámetros de las VP ni en los parámetros clínicos estudiados en ambos grupos.

Conclusión

El volumen de la aurícula izquierda es mayor en pacientes con FA persistente y en pacientes que no responden al procedimiento de ablación.

Palabras clave:
Tomografía computarizada
Venas pulmonares
Fibrilación auricular
Ablación mediante catéter

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