Hoffmeister Peter S, Chaudhry G Muqtada, Mendel Jeffrey, Almasry Ibrahim, Tahir Syed, Marchese Thomas, Haffajee Charles I, Orlov Michael V
Division of Cardiac Electrophysiology, Department of Radiology, Caritas Saint Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
J Interv Card Electrophysiol. 2007 Apr;18(3):217-23. doi: 10.1007/s10840-007-9096-y. Epub 2007 May 22.
Increasing use of catheter ablation in the left atrium (LA) requires understanding of substrate anatomy, especially with regard to potential damage to adjacent structures.
We reviewed multidetector helical computed tomography (MDCT) imaging on 42 subjects, 26 imaged before planned LA ablation for atrial fibrillation (AF), and 16 without AF. LA volume and dimensions were larger in patients with AF (p < 0.05) and the spine and aorta (Ao) impressed the LA more frequently in the AF group. The esophagus (Eo) was the predominant feature on the posterior LA wall, contacting it in all patients. The Ao was in contact with the LA body or the left inferior pulmonary vein (PV) in 32 (76%) of 42 cases, and in 10 it ran along an indentation on the posterior aspect of the LA. The coronary sinus was adjacent to LA ablation sites, the azygos vein was rarely adjacent to those sites, and the left bronchus abutted the PV ostium but not the LA. Two patients had findings that directly impacted the ablation procedure: one patient had a dilated fluid filled Eo with esophageal stricture and underwent nasogastric decompression before ablation, and one was discovered to have an anomalous PV and underwent surgical repair.
MDCT imaging identifies structures adjacent to the LA, which could be affected by ablation. Posterior LA topography can be influenced by the position of the Ao or by the proximity of the spine. Preprocedural imaging can characterize anatomic structures that could be vulnerable during ablation, and detect unusual pathology that can affect the treatment plan.
左心房（LA）导管消融术的应用日益增多，这需要了解其基质解剖结构，尤其是关于对相邻结构的潜在损伤。
我们回顾了42例受试者的多排螺旋计算机断层扫描（MDCT）成像，其中26例在计划进行房颤（AF）的LA消融术前成像，16例无房颤。AF患者的LA容积和尺寸更大（p<0.05），脊柱和主动脉（Ao）在AF组中对LA的压迫更频繁。食管（Eo）是LA后壁的主要特征，在所有患者中均与LA后壁接触。42例中有32例（76%）Ao与LA主体或左下肺静脉（PV）接触，10例沿LA后壁的压迹走行。冠状窦邻近LA消融部位，奇静脉很少邻近这些部位，左支气管邻接PV开口但不邻接LA。两名患者的检查结果直接影响了消融手术：一名患者食管扩张并充满液体且伴有食管狭窄，在消融术前进行了鼻胃减压，另一名患者被发现有异常PV并接受了手术修复。
MDCT成像可识别LA邻近的可能受消融影响的结构。LA后壁的地形可能受Ao位置或脊柱 proximity的影响。术前成像可明确消融过程中可能易受损伤的解剖结构，并检测出可能影响治疗方案的异常病变。
