title: Coexistence of left-sided atrioventricular accessory pathways with a common inferior pulmonary vein ostium.
abstract: BACKGROUND
  As the technique for radiofrequency catheter ablation for atrial fibrillation (AF) has progressed, so has our knowledge of both normal and abnormal anatomy of the left atrium and pulmonary veins (PV). We treated several AF patients with accessory conduction pathways (ACP) who were also found to have a common ostium of inferior PVs (CIPV), a relatively rare PV anomaly. No relation between ACP and PV anomalies has ever been reported, and the aim of our study was to study this association.
  
  
  RESULTS
  This study included 137 consecutive patients (104 men; mean age, 60±9 years) who underwent AF ablation for paroxysmal and persistent AF at our institution from March 2009 to August 2010. We analyzed coexisting supraventricular tachycardias and left atrium and PV morphology by multidetector row CT. Thirty-eight of 137 patients (27.7%) were found to have some PV anomaly, consisting of 13 with a common trunk of left PV, 19 with right additional PV, 3 with a common trunk of right PV, and 3 with CIPV. Thirty-one patients (22.6%) had supraventricular tachycardias. They were 26 cases of atrial flutter, 4 of Wolff-Parkinson-White syndrome, and 3 of atrioventricular nodal reentrant tachycardia. The prevalence of a coexisting ACP was significantly higher in patients with CIPV than in those without CIPV (3 of 3 [100%] versus 1 in 134 [0.7%]; P<0.0001). All ACPs with CIPV were located in the left side. The other supraventricular tachycardias were not associated with any PV anomalies.
  
  
  CONCLUSIONS
  There is a possible association between CIPV and left-sided ACP in AF patients. This suggests that there is a likelihood of developmental association between them.
authors.affiliation: Department of Cardiology, Saitama Red Cross Hospital, Saitama-City, Japan. ihara-tmd@umin.ac.jp
authors.forename: Kensuke
authors.initials: K
authors.lastname: Ihara
authors.forename: Junichi
authors.initials: J
authors.lastname: Nitta
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Iwai
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Asano
authors.forename: Miki
authors.initials: M
authors.lastname: Kanoh
authors.forename: Kenichi
authors.initials: K
authors.lastname: Muramatsu
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Yamato
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Kazuyasu
authors.initials: K
authors.lastname: Takei
authors.forename: Kihiro
authors.initials: K
authors.lastname: Asakawa
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D002036:Bundle of His / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome