title: Morphologic analysis of left atrial anatomy by magnetic resonance angiography in patients with atrial fibrillation: a large single center experience.
abstract: LA and PV Anatomy in Patients With AF.
  
  
  BACKGROUND
  Although transcatheter atrial fibrillation (AF) ablation requires accurate anatomic knowledge, pulmonary vein (PV) anatomy has not been fully investigated. Aim of this study is to describe left atrium (LA) and PV anatomy by magnetic resonance angiography (MRA) in a large cohort of patients with AF.
  
  
  METHODS
  MRA was performed in 473 patients preceding transcatheter AF ablation (paroxysmal 60.9%; persistent 39.1%). The Venice Chart classification was used to classify PV branching patterns.
  
  
  RESULTS
  About 40% of the patients presented typical PV branching pattern (2 left and 2 right PVs). A representative number of patients presented a common left trunk (19.9% and 11.0% short and long, respectively). A right middle PV was described in 12.5% and 2 right middle PVs in 1.5% patients. The remaining patients presented other complex, previously unclassified patterns: 6.3% presented an accessory PV originating from LA areas not describable as right or "upper" and 8.7% a common left trunk plus right middle PV. Diameters and circumference of each PV, LA, and LA appendage volumes resulted larger in patients presenting persistent compared to paroxysmal AF (P < 0.001).
  
  
  CONCLUSIONS
  This study highlights that "typical" PV branching pattern is not a common finding. That 25.6% of the patients present at least 1 accessory PV needs to be kept in careful consideration when planning and performing transcatheter AF ablation. In addition, not only LA volume, but also each PV ostia and LA appendage are significantly enlarged in patients with persistent compared to paroxysmal AF.
authors.affiliation: Cardiology Division, Department of Internal Medicine, University of Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Alessandro
authors.initials: A
authors.lastname: Blandino
authors.forename: Serena
authors.initials: S
authors.lastname: Beninati
authors.forename: Chiara
authors.initials: C
authors.lastname: Rovera
authors.forename: Carlo
authors.initials: C
authors.lastname: Boffano
authors.forename: Marco
authors.initials: M
authors.lastname: Belletti
authors.forename: Domenico
authors.initials: D
authors.lastname: Caponi
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.forename: Federico
authors.initials: F
authors.lastname: Cesarani
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D001281:Atrial Fibrillation / Q000473:pathology*; D005260:Female; D006325:Heart Atria / Q000002:abnormalities* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000473:pathology*