Anatomic characteristics of the left atrial isthmus in patients with atrial fibrillation: lessons from computed tomographic images.
BACKGROUND
Left atrial (LA) isthmus ablation was reported to improve the success rate of catheter ablation of paroxysmal atrial fibrillation (AF). LA isthmus ablation could also cure a subset of LA flutter. Therefore, understanding the anatomy of the LA isthmus is important for performing the ablation effectively.


RESULTS
Group I included 45 patients (40 male, mean age = 50 +/- 13 years) with paroxysmal AF who underwent catheter ablation. Group II included 45 patients (37 male, mean age = 54 +/- 10 years) without a history of AF. They underwent a 16-slice multidetector computed tomography (MDCT) scan to delineate the LA structures before the ablation procedure. The average length of the LA isthmus was longer in group I than in group II (lateral isthmus: 3.30 +/- 0.68 vs 2.71 +/- 0.60 cm, P < 0.001; medial isthmus: 5.12 +/- 0.94 vs 4.45 +/- 0.63 cm, P < 0.001), and morphological patterns of lateral and medial isthmus were similar between groups. In addition, the average depth of lateral isthmus was similar between groups (0.62 +/- 0.32 vs 0.55 +/- 0.33 cm, P = 0.41), but the average depth of medial isthmus was larger in group I than in group II (0.60 +/- 0.32 vs 0.44 +/- 0.25 cm, P = 0.01). The medial isthmus had more ridges, as compared to the lateral isthmus (13% vs 0%, P = 0.026). Furthermore, the distances between esophagus and lateral isthmus were longer in group I than in group II (at the middle of isthmus and mitral annulus level: 21.0 +/- 4.8 vs 18.4 +/- 6.0 mm, P < 0.001; and 37.1 +/- 5.7 vs 29.6 +/- 8.1 mm, P < 0.001, respectively).


CONCLUSIONS
The LA isthmus was longer in the AF patients. The morphology of the isthmus was variable. Compared with the lateral isthmus, the medial isthmus was longer and had more ridges. A peculiar configuration of the isthmus provided by CT images could influence the ablation strategy.
Chiang
Shuo-Ju
SJ
Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, Taiwan.
Tsao
Hsuan-Ming
HM
Wu
Mei-Han
MH
Tai
Ching-Tai
CT
Chang
Shih-Lin
SL
Wongcharoen
Wanwarang
W
Lin
Yenn-Jiang
YJ
Lo
Li-Wei
LW
Chen
Yi-Jen
YJ
Sheu
Ming-Huei
MH
Chang
Cheng-Yen
CY
Chen
Shih-Ann
SA
D000886:Anthropometry / Q000379:methods; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*