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(Circulation. 2003;107:2004.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Pulmonary Vein Anatomy in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Lessons Learned by Use of Magnetic Resonance Imaging

Ritsushi Kato, MD; Lars Lickfett, MD; Glenn Meininger, MD; Timm Dickfeld, MD; Richard Wu, MD; George Juang, MD; Piamsook Angkeow, MD; Jennifer LaCorte, BSN; David Bluemke, MD, PhD; Ronald Berger, MD, PhD; Henry R. Halperin, MD, MA; Hugh Calkins, MD

From the Departments of Medicine (R.K., L.L., G.M., T.D., R.W., G.J., P.A., R.B., H.R.H., H.C.), Radiology (D.B., H.R.H.), and Biomedical Engineering (H.R.H.), Johns Hopkins University School of Medicine, Baltimore, Md.

Correspondence to Hugh Calkins, MD, The Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 592, Baltimore, MD 21287-0409. E-mail hcalkins{at}jhmi.edu

Background— This study sought to define the technique and results of magnetic resonance imaging (MRI) of pulmonary vein (PV) anatomy before and after catheter ablation of atrial fibrillation (AF).

Methods and Results— Twenty-eight patients with AF underwent ablation. Patients underwent gadolinium-enhanced MRI before and 6 weeks after their procedures. A control group of 27 patients also underwent MRI. Variant PV anatomy was observed in 38% of patients. AF patients had larger PV diameters than control subjects, but no difference was observed in the size of the PV ostia among AF patients. The PV ostia were oblong in shape with an anteroposterior dimension less than the superoinferior dimension. The left PVs had a longer "neck" than the right PVs. A detectable PV narrowing was observed in 24% of veins. The severity of stenosis was severe in 1 vein (1.4%), moderate in 1 vein (1.4%), and mild in 15 veins (21.1%). All patients were asymptomatic, and none required treatment.

Conclusions— This study demonstrates that AF patient have larger PVs than control subjects and demonstrates the value of MRI in facilitating AF ablation. The benefits of preprocedural MRI of PVs include the ability to evaluate the number, size, and shape of the PVs. MRI also provides an assessment of the severity of PV stenosis.

Key Words: veins • lung • fibrillation • imaging • catheter ablation

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