Technique and results of pulmonary vein angiography in patients undergoing catheter ablation of atrial fibrillation.
BACKGROUND
Delineation of pulmonary vein (PV) anatomy is an integral part of the PV isolation procedure. The aims of the present study were to (1) describe the technique of selective PV angiography, (2) show the typical fluoroscopic locations and appearance of the PVs, and (3) compare the ostial diameters of PVs measured by angiography and magnetic resonance imaging (MRI).


RESULTS
Twenty consecutive patients undergoing a PV isolation procedure underwent selective PV angiography using a deflectable 8-French lumened catheter (Naviport, Cardima). The left superior PV (LSPV) runs upward and away from the spine in the right anterior oblique (RAO) projection and upward and toward the spine in the left anterior oblique (LAO) projection. The opposite is true for the right superior PV (RSPV). The left inferior PV (LIPV) has a bull's-eye appearance in the RAO projection, and the right inferior PV (RIPV) has a bull's-eye appearance in the LAO projection due to their end-on trajectories. The LIPV in the LAO projection and the RIPV in the RAO projection run horizontally toward the spine. An excellent correlation was noted in PV ostial size as assessed by angiography and MRI (r(2) < 0.90, P < 0.0001).


CONCLUSIONS
This study describes the technique and results of PV angiography and fluoroscopy. The study also demonstrates good correlation of PV ostial diameters by contrast venography and MRI. PV angiography can be used as an alternate to MRI or computed tomographic imaging, particularly when these tests are unavailable or are contraindicated in the patient.
Vasamreddy
Chandreaekhar R
CR
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jayam
Vinod
V
Lickfett
Lars
L
Nasir
Khurram
K
Bradley
David J
DJ
Eldadah
Zayd
Z
Dickfeld
Timm
T
Donahue
Kevin
K
Halperin
Henry S
HS
Berger
Ronald
R
Calkins
Hugh
H
D001281:Atrial Fibrillation / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010690:Phlebography / Q000379:methods; D011379:Prognosis; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity