title: Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Circumferential pulmonary vein (PV) isolation is the cornerstone of catheter ablation for atrial fibrillation (AF); however, PV reconnection remains problematic.
  
  
  OBJECTIVE
  To assess the impact of PV anatomy on outcome after AF ablation.
  
  
  METHODS
  One hundred two patients with paroxysmal AF underwent cardiac magnetic resonance (60%) or computed tomography (40%) before AF ablation. PV anatomy was classified according to the presence of common PVs, accessory PVs, PV branching pattern, and the dimensions of the PV ostia, intervenous ridges (IVRs), and the left PV-left atrial appendage ridge.
  
  
  RESULTS
  Four discrete PVs were present in 48(47%) of the patients: a left common PV in 38(37%), a right common PV in 2(2%), an accessory right PV in 20(20%), and left PV in 4(4%). At a mean follow-up of 12 ± 4 months, 75 of 102 (74%) patients were free of recurrent AF. A LCPV was associated with an increase in freedom from AF (87% vs 66% for 4 PV anatomy; P = .03). Greater left IVR length (16.9 ± 3.5 mm vs 14.0 ± 3.0 mm; P ≤ .001) and width (1.4 ± 0.6 mm vs 1.1 ± 0.6 mm; P = .02) were associated with increased AF recurrence. After multivariate analysis, abnormal anatomy (LCPV or accessory PV) and left IVR length were found to be the only independent predictors of freedom from AF.
  
  
  CONCLUSIONS
  Four discrete PVs are present in the minority of patients with paroxysmal AF undergoing PV isolation. The presence of a LCPV is associated with an increased freedom from AF after catheter ablation. PV anatomy may in part explain the variable outcome to electrical isolation in patients with paroxysmal AF.
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Alex J A
authors.initials: AJ
authors.lastname: McLellan
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Liang-han
authors.initials: LH
authors.lastname: Ling
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
authors.forename: Diego
authors.initials: D
authors.lastname: Ruggiero
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Michael C G
authors.initials: MC
authors.lastname: Wong
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Tomos E
authors.initials: TE
authors.lastname: Walters
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Nisbet
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Anoop K
authors.initials: AK
authors.lastname: Shetty
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
authors.forename: Sonia
authors.initials: S
authors.lastname: Azzopardi
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne Private Hospital, Parkville, Victoria, Australia.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Morton
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne Private Hospital, Parkville, Victoria, Australia.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.affiliation: Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne Private Hospital, Parkville, Victoria, Australia. Electronic address: peter.kistler@bakeridi.edu.au.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000033:anatomy & histology* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Ablation; Anatomy; Atrial fibrillation; Intervenous ridge; Pulmonary vein isolation