Characteristics in image integration system guiding catheter ablation of atrial fibrillation with a common ostium of inferior pulmonary veins.
BACKGROUND
Common ostium of the inferior pulmonary veins (PVs) is a kind of unusual variation in pulmonary venous drainage to the left atrium (LA), whose feature of anatomy, electrophysiology, and catheter ablation is rarely demonstrated, and the consecutive series of research for catheter ablation of atrial fibrillation (AF) in patients with that anomaly have not been reported.


METHODS
A total of 1,226 patients with drug-refractory AF received magnetic resonance angiography (MRA) or multidetector computed tomography (MDCT) scan before ablation. Electrophysiological mapping was used to detect the focal triggers in paroxysmal AF. Basic catheter ablation strategy was circumferential PV isolation with "tricircle" under the guidance of image integration system: two circles surround two superior PVs, and the other surround the common trunk.


RESULTS
LA and PVs reconstruction by image integration system showed a common pulmonary venous ostium of the right and left inferior PVs before ablation in 11 patients (0.9%). This anomaly could be classified into two types: type A without a short common trunk of inferior PVs and type B with a short common trunk. Fifty-seven percent paroxysmal AF was revealed focal triggers in the common ostium. The success rate of that strategy was 90%.


CONCLUSIONS
Common ostium of inferior PVs could be classified into two types according to the presence of a short common trunk or not. The common ostium was usually an important triggering focus in paroxysmal AF. Catheter ablation strategy of circumferential PV isolation with "tricircle" under the guidance of image integration system would be a good choice.
Yu
Ronghui
R
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Dong
Jianzeng
J
Zhang
Zhaoqi
Z
Liu
Xingpeng
X
Kang
Junping
J
Long
Deyong
D
Fang
Dongping
D
Tang
Ribo
R
Guo
Xi
X
Hu
Fuli
F
Ma
Changsheng
C
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D003287:Contrast Media; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000002:abnormalities*; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome
D003287:Contrast Media; D019786:Gadolinium DTPA