This Article Full Text Full Text (PDF) All Versions of this Article: 107/1/21    most recent 01.CIR.0000047065.49852.8Fv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wittkampf, F. H.M. Articles by Cramer, M.-J. Search for Related Content PubMed PubMed Citation Articles by Wittkampf, F. H.M. Articles by Cramer, M.-J. Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2003;107:21.)
© 2003 American Heart Association, Inc.

Brief Rapid Communications

Pulmonary Vein Ostium Geometry

Analysis by Magnetic Resonance Angiography

Fred H.M. Wittkampf, PhD; Evert-Jan Vonken, MD; Richard Derksen, MD; Peter Loh, MD; Birgitta Velthuis, MD; Eric F.D. Wever, MD; Lucas V.A. Boersma, MD; Benno J. Rensing, MD; Maarten-Jan Cramer, MD

From the Department of Cardiology, Heart Lung Center Utrecht (F.H.M.W., R.D., P.L., E.F.D.W., L.V.A.B., B.J.R., M.-J.C.), and Department of Radiology, University Medical Center Utrecht (E.-J.V., B.V.), Utrecht, The Netherlands.

Correspondence to Fred Wittkampf, University Medical Center E03-406, PO Box 85500, 3508 GA, Utrecht, The Netherlands. E-mail fredwittkampf{at}mac.com

Background— During a catheter ablation procedure for selective electrical isolation of pulmonary vein (PV) ostia, the size of these ostia is usually estimated using fluoroscopic angiography. This measurement may be misleading, however, because only the projected supero/inferior ostium diameters can be measured. In this study, we analyzed 3-dimensional magnetic resonance angiographic (MRA) images to measure the minimal and maximal cross-sectional diameter of PV ostia in relation to the diameter that would have been projected on fluoroscopic angiograms during a catheter ablation procedure.

Methods and Results— In 42 patients with idiopathic atrial fibrillation who were scheduled for selective electrical isolation of PV ostia, the minimal and maximal diameters of these ostia were measured from 3-dimensional MRA images. Thereafter, these images were oriented in a 45° right or left anterior oblique direction and the projected diameter of the PV ostia were measured again. The average ratio between maximal and minimal diameter was 1.5±0.4 for the left and 1.2±0.1 for the right pulmonary vein ostia. Because of the orientation and oval shape of especially the left pulmonary vein ostia, their minimal diameters were significantly smaller than the projected diameters.

Conclusion— Pulmonary vein ostia, especially those at the left, are oval with the short axis oriented approximately in the antero/posterior direction. Consequently, PV ostia may sometimes be very narrow despite a rather normal appearance on angiographic images obtained during a catheter ablation procedure.

Key Words: fibrillation • atrium • veins • magnetic resonance imaging • catheter ablation

This article has been cited by other articles:

				V. Y. Reddy, P. Neuzil, S. Themistoclakis, S. B. Danik, A. Bonso, A. Rossillo, A. Raviele, R. Schweikert, S. Ernst, K.-H. Kuck, et al. Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation: Experimental Feasibility and First-in-Human Multicenter Clinical Outcome Circulation, July 7, 2009; 120(1): 12 - 20. [Abstract] [Full Text] [PDF]

				C. J. Francois, D. Tuite, V. Deshpande, R. Jerecic, P. Weale, and J. C. Carr Pulmonary Vein Imaging with Unenhanced Three-dimensional Balanced Steady-State Free Precession MR Angiography: Initial Clinical Evaluation Radiology, March 1, 2009; 250(3): 932 - 939. [Abstract] [Full Text] [PDF]

				T. H. Hauser, D. C. Peters, J. V. Wylie, and W. J. Manning Evaluating the left atrium by magnetic resonance imaging Europace, November 1, 2008; 10(suppl_3): iii22 - iii27. [Abstract] [Full Text] [PDF]

				H. Niinuma, R. T. George, A. Arbab-Zadeh, J. A.C. Lima, and C. A. Henrikson Imaging of pulmonary veins during catheter ablation for atrial fibrillation: the role of multi-slice computed tomography Europace, November 1, 2008; 10(suppl_3): iii14 - iii21. [Abstract] [Full Text] [PDF]

				X. Huang, Y. Huang, T. Huang, W. Huang, and Z. Huang Individual pulmonary vein imaging by transthoracic echocardiography: an inadequate traditional interpretation Eur J Echocardiogr, September 1, 2008; 9(5): 655 - 660. [Abstract] [Full Text] [PDF]

				C. Schneider, S. Ernst, E. Bahlmann, R. Malisius, U. Krumsdorf, S. Boczor, F. Lampe, M. Hoffmann-Riem, K.-H. Kuck, and M. Antz Transesophageal echocardiography: A screening method for pulmonary vein stenosis after catheter ablation of atrial fibrillation Eur J Echocardiogr, December 1, 2006; 7(6): 447 - 456. [Abstract] [Full Text] [PDF]

				O. M. Wazni, H.-M. Tsao, S.-A. Chen, H.-H. Chuang, W. Saliba, A. Natale, and A. L. Klein Cardiovascular Imaging in the Management of Atrial Fibrillation J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2077 - 2084. [Abstract] [Full Text] [PDF]

				N. R. Van de Veire, J. D. Schuijf, J. De Sutter, D. Devos, G. B. Bleeker, A. de Roos, E. E. van der Wall, M. J. Schalij, and J. J. Bax Non-Invasive Visualization of the Cardiac Venous System in Coronary Artery Disease Patients Using 64-Slice Computed Tomography J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1832 - 1838. [Abstract] [Full Text] [PDF]

				P. H. van der Voort, H. van den Bosch, J. C. Post, and A. Meijer Determination of the spatial orientation and shape of pulmonary vein ostia by contrast-enhanced magnetic resonance angiography. Europace, January 1, 2006; 8(1): 1 - 6. [Abstract] [Full Text] [PDF]

				J. Ector, S. De Buck, J. Adams, S. Dymarkowski, J. Bogaert, F. Maes, and H. Heidbuchel Cardiac Three-Dimensional Magnetic Resonance Imaging and Fluoroscopy Merging: A New Approach for Electroanatomic Mapping to Assist Catheter Ablation Circulation, December 13, 2005; 112(24): 3769 - 3776. [Abstract] [Full Text] [PDF]

				Y.-H. Kim, E. M. Marom, J. E. Herndon II, and H. P. McAdams Pulmonary Vein Diameter, Cross-sectional Area, and Shape: CT Analysis Radiology, April 1, 2005; 235(1): 43 - 49. [Abstract] [Full Text] [PDF]

				M. R.M. Jongbloed, H. J. Lamb, J. J. Bax, J. D. Schuijf, A. de Roos, E. E. van der Wall, and M. J. Schalij Noninvasive visualization of the cardiac venous system using multislice computed tomography J. Am. Coll. Cardiol., March 1, 2005; 45(5): 749 - 753. [Abstract] [Full Text] [PDF]

				M. R. M. Jongbloed, M. S. Dirksen, J. J. Bax, E. Boersma, K. Geleijns, H. J. Lamb, E. E. van der Wall, A. de Roos, and M. J. Schalij Atrial Fibrillation: Multi-Detector Row CT of Pulmonary Vein Anatomy prior to Radiofrequency Catheter Ablation--Initial Experience Radiology, March 1, 2005; 234(3): 702 - 709. [Abstract] [Full Text] [PDF]

				M. R.M. Jongbloed, J. J. Bax, H. J. Lamb, M. S. Dirksen, K. Zeppenfeld, E. E. van der Wall, A. de Roos, and M. J. Schalij Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation: A head-to-head comparison J. Am. Coll. Cardiol., February 1, 2005; 45(3): 343 - 350. [Abstract] [Full Text] [PDF]

				A. W. Bowman and S. J. Kovacs Prediction and assessment of the time-varying effective pulmonary vein area via cardiac MRI and Doppler echocardiography Am J Physiol Heart Circ Physiol, January 1, 2005; 288(1): H280 - H286. [Abstract] [Full Text] [PDF]

				D. Katritsis, K. A. Ellenbogen, and A. J. Camm Recurrence of left atrium-pulmonary vein conduction following successful disconnection in asymptomatic patients Europace, January 1, 2004; 6(5): 425 - 432. [Abstract] [Full Text] [PDF]

				B. Ghaye, D. Szapiro, J.-N. Dacher, L.-M. Rodriguez, C. Timmermans, D. Devillers, and R. F. Dondelinger Percutaneous Ablation for Atrial Fibrillation: The Role of Cross-sectional Imaging RadioGraphics, October 1, 2003; 23(90001): S19 - 33. [Abstract] [Full Text] [PDF]