Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins
Background: Ablation of the pulmonary vein (PV) carina is occasionally required for PV isolation (PVI). Marshall bundle and epicardial connections between the right-sided PV (RtPV) carina and right atrium (RA) may be one of the mechanisms that necessitates carina ablation. Objective: We sought to cl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-10-01
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| Series: | Heart Rhythm O2 |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501820301124 |
| _version_ | 1819096940146589696 |
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| author | Yuichi Hanaki, MD Kentaro Yoshida, MD Masako Baba, MD Hideyuki Hasebe, MD Noriyuki Takeyasu, MD Akihiko Nogami, MD Masaki Ieda, MD |
| author_facet | Yuichi Hanaki, MD Kentaro Yoshida, MD Masako Baba, MD Hideyuki Hasebe, MD Noriyuki Takeyasu, MD Akihiko Nogami, MD Masaki Ieda, MD |
| author_sort | Yuichi Hanaki, MD |
| collection | DOAJ |
| description | Background: Ablation of the pulmonary vein (PV) carina is occasionally required for PV isolation (PVI). Marshall bundle and epicardial connections between the right-sided PV (RtPV) carina and right atrium (RA) may be one of the mechanisms that necessitates carina ablation. Objective: We sought to clarify anatomical characteristics predictive of the necessity of carina ablation. Methods: Forty-five consecutive patients undergoing radiofrequency catheter ablation of atrial fibrillation were prospectively included in this study. Left atrial (LA) and PV size and morphology, and interatrial distance in the posterior aspect, were measured on cardiac computed tomography (CT) images. Results: For right-sided PVI, the patients were divided into 2 groups based on the necessity of RtPV carina ablation, Carina-ABL group (n = 21) and Non-Carina-ABL group (n = 24). The distance between the anterior portion of the RtPV carina and RA was shorter in the Carina-ABL group vs in the Non-Carina-ABL group (7.7 ± 1.7 mm/m2 vs 9.5 ± 2.3 mm/m2; P = .005), whereas other anatomical parameters (LA and RA volumes, right inferior PV angle, and ostial diameters of the RtPVs) did not differ between the groups. For left-sided PVI, the ostial diameter and circumference of the left superior PV were smaller in the Carina-ABL group (n = 13) vs the Non-Carina-ABL group (n = 32) (8.6 ± 2.1 mm/m2 vs 7.3 ± 1.5 mm/m2; P = .044, and 34.9 ± 6.0 mm/m2 vs 30.1 ± 5.1 mm/m2; P = .017, respectively). Conclusions: A shorter interatrial distance for right-sided PVI and a smaller PV ostium for left-sided PVI were associated with the necessity of additional carina ablation. The presence and location of the epicardial fibers may be affected by the atrial and PV geometry. |
| first_indexed | 2024-12-22T00:07:10Z |
| format | Article |
| id | doaj.art-b3ae88d578d14e07b68a4c183216003d |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-12-22T00:07:10Z |
| publishDate | 2020-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-b3ae88d578d14e07b68a4c183216003d2022-12-21T18:45:33ZengElsevierHeart Rhythm O22666-50182020-10-0114259267Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veinsYuichi Hanaki, MD0Kentaro Yoshida, MD1Masako Baba, MD2Hideyuki Hasebe, MD3Noriyuki Takeyasu, MD4Akihiko Nogami, MD5Masaki Ieda, MD6Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan; Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanDepartment of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan; Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Address reprint requests and correspondence: Dr Kentaro Yoshida, Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan.Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan; Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanDepartment of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanDepartment of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, JapanDepartment of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanDepartment of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanBackground: Ablation of the pulmonary vein (PV) carina is occasionally required for PV isolation (PVI). Marshall bundle and epicardial connections between the right-sided PV (RtPV) carina and right atrium (RA) may be one of the mechanisms that necessitates carina ablation. Objective: We sought to clarify anatomical characteristics predictive of the necessity of carina ablation. Methods: Forty-five consecutive patients undergoing radiofrequency catheter ablation of atrial fibrillation were prospectively included in this study. Left atrial (LA) and PV size and morphology, and interatrial distance in the posterior aspect, were measured on cardiac computed tomography (CT) images. Results: For right-sided PVI, the patients were divided into 2 groups based on the necessity of RtPV carina ablation, Carina-ABL group (n = 21) and Non-Carina-ABL group (n = 24). The distance between the anterior portion of the RtPV carina and RA was shorter in the Carina-ABL group vs in the Non-Carina-ABL group (7.7 ± 1.7 mm/m2 vs 9.5 ± 2.3 mm/m2; P = .005), whereas other anatomical parameters (LA and RA volumes, right inferior PV angle, and ostial diameters of the RtPVs) did not differ between the groups. For left-sided PVI, the ostial diameter and circumference of the left superior PV were smaller in the Carina-ABL group (n = 13) vs the Non-Carina-ABL group (n = 32) (8.6 ± 2.1 mm/m2 vs 7.3 ± 1.5 mm/m2; P = .044, and 34.9 ± 6.0 mm/m2 vs 30.1 ± 5.1 mm/m2; P = .017, respectively). Conclusions: A shorter interatrial distance for right-sided PVI and a smaller PV ostium for left-sided PVI were associated with the necessity of additional carina ablation. The presence and location of the epicardial fibers may be affected by the atrial and PV geometry.http://www.sciencedirect.com/science/article/pii/S2666501820301124AblationAtrial fibrillationCarinaEpicardial connectionPulmonary vein |
| spellingShingle | Yuichi Hanaki, MD Kentaro Yoshida, MD Masako Baba, MD Hideyuki Hasebe, MD Noriyuki Takeyasu, MD Akihiko Nogami, MD Masaki Ieda, MD Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins Heart Rhythm O2 Ablation Atrial fibrillation Carina Epicardial connection Pulmonary vein |
| title | Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins |
| title_full | Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins |
| title_fullStr | Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins |
| title_full_unstemmed | Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins |
| title_short | Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins |
| title_sort | interatrial distance predicts the necessity of additional carina ablation to isolate the right sided pulmonary veins |
| topic | Ablation Atrial fibrillation Carina Epicardial connection Pulmonary vein |
| url | http://www.sciencedirect.com/science/article/pii/S2666501820301124 |
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