Cardiology Division, Department of Internal Medicine, University of Turin, Italy.
J Cardiovasc Electrophysiol. 2011 Jan;22(1):1-7. doi: 10.1111/j.1540-8167.2010.01853.x.
LA and PV Anatomy in Patients With AF.
Although transcatheter atrial fibrillation (AF) ablation requires accurate anatomic knowledge, pulmonary vein (PV) anatomy has not been fully investigated. Aim of this study is to describe left atrium (LA) and PV anatomy by magnetic resonance angiography (MRA) in a large cohort of patients with AF.
MRA was performed in 473 patients preceding transcatheter AF ablation (paroxysmal 60.9%; persistent 39.1%). The Venice Chart classification was used to classify PV branching patterns.
About 40% of the patients presented typical PV branching pattern (2 left and 2 right PVs). A representative number of patients presented a common left trunk (19.9% and 11.0% short and long, respectively). A right middle PV was described in 12.5% and 2 right middle PVs in 1.5% patients. The remaining patients presented other complex, previously unclassified patterns: 6.3% presented an accessory PV originating from LA areas not describable as right or "upper" and 8.7% a common left trunk plus right middle PV. Diameters and circumference of each PV, LA, and LA appendage volumes resulted larger in patients presenting persistent compared to paroxysmal AF (P < 0.001).
This study highlights that "typical" PV branching pattern is not a common finding. That 25.6% of the patients present at least 1 accessory PV needs to be kept in careful consideration when planning and performing transcatheter AF ablation. In addition, not only LA volume, but also each PV ostia and LA appendage are significantly enlarged in patients with persistent compared to paroxysmal AF.
标题：房颤患者左心房和肺静脉解剖。
简介：尽管经导管房颤（AF）消融需要准确的解剖学知识，但肺静脉（PV）解剖尚未得到充分研究。本研究旨在通过磁共振血管造影（MRA）描述大量 AF 患者的左心房（LA）和 PV 解剖结构。
方法：在 473 例行经导管 AF 消融的患者（阵发性 60.9%；持续性 39.1%）前行 MRA。使用威尼斯图表分类法对 PV 分支模式进行分类。
结果：约 40%的患者呈现典型的 PV 分支模式（2 个左和 2 个右 PV）。相当数量的患者存在共同的左干（短干和长干分别为 19.9%和 11.0%）。12.5%的患者存在右中 PV，1.5%的患者存在 2 个右中 PV。其余患者呈现其他复杂的、以前未分类的模式：6.3%的患者存在发自 LA 区域、无法描述为右或“上部”的副 PV，8.7%的患者存在共同的左干和右中 PV。与阵发性 AF 相比，持续性 AF 患者的各 PV、LA 和 LA 附件的直径和周长更大（P<0.001）。
结论：本研究强调“典型”PV 分支模式并非常见发现。25.6%的患者至少存在 1 个副 PV，在计划和进行经导管 AF 消融时需要仔细考虑。此外，与阵发性 AF 相比，持续性 AF 患者不仅 LA 容积增大，而且各 PV 口和 LA 附件也显著增大。
