1st Department of Cardiology, Medical University of Silesia, Silesian Heart Center, Ziolowa 47, 40-635 Katowice, Poland.
Int J Cardiol. 2011 Jan 21;146(2):181-5. doi: 10.1016/j.ijcard.2009.06.047. Epub 2009 Jul 25.
A possible role of anomalies in number and insertion of pulmonary veins (PV) in initiating atrial fibrillation (AF) has been suggested. It has been shown as well that changes in anatomy of PVs such as enlargement may have an effect on arrhythmogenesis. The aim of the study was to compare anatomy of the left atrium (LA) and PVs in patients with AF and control subjects.
Eighty two patients were evaluated with 64-slice computed tomography (MSCT). Fifty one of them were referred to catheter ablation with history of highly symptomatic AF--AF(+) group. Thirty one control subjects had no history of AF and were referred to MSCT for noninvasive evaluation of different pathologies which finally were excluded--AF(-) group. Study groups did not differ in regard to age, sex, presence of hypertension and left ventricular systolic function. Diameters of PV ostia were measured in anterior-posterior (AP) and superior-inferior (SI) directions. Venous ostium index was calculated as a ratio between these measurements.
The diameter of LA was higher in AF(+) patients than in the AF(-) patients (39±6 mm vs. 35±4 mm, p<0.005). In 68.6% of AF(+) patients and in 83.9% of AF(-) patients the anatomical pattern was typical with two right and two left PVs. Additional PVs were detected in 6 patients, only in AF(+) group (p<0.05). Common ostia were more frequently found in AF(+) subjects (37.2% vs. 19.3, p=0,08), mainly left-sided. In AF(+) group mean SI diameters of both-sided superior PVs and left inferior veins were larger. All AP diameters except for right inferior PVs were also larger in AF(+) group than in control cases.
Variations in the PVs anatomy are more common and diameters of ostial portions of the veins are larger in AF patients than in control subjects. These findings suggest that further studies on the role of structural abnormalities of PVs in arrhythmogenesis are needed.
比较房颤（AF）患者与对照组左心房（LA）和肺静脉（PV）解剖结构的差异。
82 例患者行 64 排 CT（MSCT）检查。其中 51 例因症状性 AF 病史行导管消融术（AF(+)组）。31 例无 AF 病史且因其他病变行 MSCT 检查的患者作为对照组（AF(-)组）。两组患者在年龄、性别、高血压和左心室收缩功能方面无差异。测量 PV 口的前后径（AP）和上下径（SI），计算两者比值作为静脉口指数。
与 AF(-)组相比，AF(+)组 LA 直径更大（39±6mm vs. 35±4mm，p<0.005）。68.6%的 AF(+)组和 83.9%的 AF(-)组存在典型的解剖结构，即 2 个右肺静脉和 2 个左肺静脉。AF(+)组有 6 例（p<0.05）存在额外的 PV。AF(+)组更常出现共同静脉开口（37.2% vs. 19.3%，p=0.08），主要为左侧。AF(+)组双侧上肺静脉和左下肺静脉的 SI 直径更大。除了右肺下静脉外，AF(+)组的所有 AP 直径均大于对照组。
与对照组相比，AF 患者的 PV 解剖结构变异更常见，PV 口直径更大。这些发现提示需要进一步研究 PV 结构异常在心律失常发生中的作用。
