title: Pre-procedural evaluation of the left atrial anatomy in patients referred for catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Cardiac computed tomography (CT) provides accurate imaging of the pulmonary vein (PV) and left atrial (LA) anatomy. This study aimed to evaluate the prevalence and morphological characteristics of anatomical variants that could influence atrial fibrillation (AF) ablation procedures.
  
  
  RESULTS
  One thousand forty consecutive patients (62±10 years, 243 female, 644 paroxysmal AF) undergoing pre-procedural imaging with a 320-row CT and their first AF ablation procedure were analyzed. A total of 194 (18.7%) patients had anatomical variants. Left, right, and inferior common PVs were observed in 118, 5, and 6 patients, respectively. Three right and left PVs were observed in 44 and 4 patients, respectively. Three patients had remnants of PVs after lobectomies, and significant PV stenosis was observed in one. Supernumerary PVs that drained into the LA and diverticula were observed in eight patients. One patient had a string-like structure connecting the LA septum and posterior LA, and the others had membranous structures incompletely compartmentalizing the LA. Three patients had persistent left superior vena cavae, two strong deviations of the LA and PVs, and one dexiocardia. All patients underwent successful PV isolation during the index procedure.
  
  
  CONCLUSIONS
  Patients referred for AF ablation often have anatomical variants, which could influence the procedure. This information might aid in planning procedural strategies, and reducing unexpected procedural complications in AF ablation.
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kanaji
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan. Electronic address: mshinsuke@k3.dion.ne.jp.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Iwasawa
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Ichihara
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Kuroi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006325:Heart Atria / Q000002:abnormalities / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011300:Preoperative Care; D011667:Pulmonary Veins / Q000002:abnormalities / Q000000981:diagnostic imaging
keywords: Anatomical variant; Atrial fibrillation; Catheter ablation; Computed tomography