title: A comparison of pulmonary vein ostial anatomy by computerized tomography, echocardiography, and venography in patients with atrial fibrillation having radiofrequency catheter ablation.
abstract: Accurate assessment of pulmonary vein anatomy is important to procedures that isolate these structures in patients with atrial fibrillation. Various modalities of pulmonary vein (PV) imaging are employed in clinical practice; however, the consistency of findings among the different modalities is unknown. The purpose of this study is to compare PV ostial anatomy by 4 common imaging techniques. Twenty-four patients undergoing catheter-based PV isolation procedures for atrial fibrillation had their PV ostial anatomy determined by cardiac computerized tomography (CT) and transesophageal echocardiography (TEE) before ablation and by intracardiac echocardiography (ICE) and venography during the ablation procedure. The number and maximal dimension of the PV ostia were determined by each imaging modality. In the 24 patients, 98 PV ostia were visualized by CT, 93 by ICE, 81 by TEE, and 71 by venography. The average ostial diameters were similar between CT (1.45 +/- 0.29 cm) and ICE (1.51 +/- 0.22 cm, p = 0.066). Compared with CT or ICE, the ostial diameters were larger with venography (1.67 +/- 0.32 cm) and smaller with TEE (1.16 +/- 0.28 cm, all p <0.001). PV ostial diameters as determined by ICE were significantly correlated with CT measurements (r = 0.57, p <0.001) and venography (r = 0.52, p <0.001). Venography measures of PV diameter were correlated with measures by CT (r = 0.33, p = 0.03). TEE measures were not correlated with any other modality (all p >/=0.43). CT identifies the greatest number of PV ostia followed by ICE. Venography overestimates and TEE underestimates ostial diameters compared with CT or ICE. The PV ostial dimensions obtained by ICE, CT, and venography are all significantly correlated.
authors.affiliation: Division of Cardiology, Virginia Commonwealth University's Medical College of Virginia, Richmond, Virginia 23298, USA. mwoodmd@pol.net
authors.forename: Mark A
authors.initials: MA
authors.lastname: Wood
authors.forename: Michael
authors.initials: M
authors.lastname: Wittkamp
authors.forename: Daniel
authors.initials: D
authors.lastname: Henry
authors.forename: Robert
authors.initials: R
authors.lastname: Martin
authors.forename: J V
authors.initials: JV
authors.lastname: Nixon
authors.forename: Richard K
authors.initials: RK
authors.lastname: Shepard
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed