The ambiguous pulmonary venoatrial junction: a new perspective.
OBJECTIVE
The pulmonary venoatrial junction (PVAJ) has recently received attention due to the widespread use of catheter ablation for atrial fibrillation. However, the literature lacks a consensus in the definition of the PVAJ. We aim to review the inconsistent definitions for the PVAJ and related implications in imaging and catheter ablation for atrial fibrillation.


RESULTS
The PVAJ as described by embryology, gross anatomy, histology and imaging is ambiguous, leading to disparities in its definition. Because of differing definitions of the PVAJ, there is a broad range in the prevalence of anatomic variations, including (1) percentage of common pulmonary veins (10-79% on the left), (2) supernumerary pulmonary veins (10-42%) and (3) ostial diameter and shape. We postulate several reasons for this broad range in the described prevalence of anatomic variation of the PV as follows: (1) different definitions of the PVAJ, (2) different vantage points, (3) different imaging modalities, and (4) different prevalence of anatomic variants among different study populations.


CONCLUSIONS
The ambiguous PVAJ with its gradual transition from the left atrium to the pulmonary veins defies precise definition even though it plays an important role in the management of atrial fibrillation. Physicians should be aware of variability in the language used to describe the PVAJ and resultant discrepancy in reported anatomical information.
Konin
Gabrielle P
GP
Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467, USA.
Jain
Vineet R
VR
Fisher
John D
JD
Haramati
Linda B
LB
D000818:Animals; D001281:Atrial Fibrillation / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D003952:Diagnostic Imaging / Q000379:methods; D006325:Heart Atria / Q000002:abnormalities / Q000196:embryology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D011667:Pulmonary Veins / Q000002:abnormalities / Q000196:embryology / Q000503:physiopathology / Q000601:surgery; D009626:Terminology as Topic