Anatomic relationship between left coronary artery and left atrium in patients undergoing atrial fibrillation ablation.
BACKGROUND
Atrial fibrillation transcatheter ablation (TCA) is, within available atrial fibrillation rhythm control strategies, one of the most effective. To potentially improve ablation outcome in case of recurrent atrial fibrillation after a first procedure or in presence of structural myocardial disease, isolation of the pulmonary veins may be associated with extensive lesions within the left atrium. To avoid rare, but potentially life-threatening, complications, thorough knowledge and assessment of left atrium anatomy and its relation to structures in close proximity are, therefore, mandatory. Aim of the present study is to describe, by cardiac computed tomography, the anatomic relationship between aortic root, left coronary artery and left atrium in patients undergoing atrial fibrillation TCA.


RESULTS
The cardiac computed tomography scan of 21 patients affected by atrial fibrillation was elaborated to segment left atrium, aortic root and left coronary artery from the surrounding structures and the following distances measured: left atrium and aortic root; left atrium roof and aortic root; left main coronary artery and left atrium; circumflex artery and left atrium appendage; and circumflex artery and mitral valve annulus. Above all, the median distance between left atrium and aortic root (1.9, 1.5-2.1 mm), and between circumflex artery and left atrium appendage ostium (3.0, 2.1-3.4 mm) were minimal (≤3 mm). None of measured distances significantly varied between patients presenting paroxysmal versus persistent atrial fibrillation.


CONCLUSIONS
The anatomic relationship between left atrium and coronary arteries is extremely relevant when performing atrial fibrillation TCA by extensive lesions. Therefore, at least in the latter case, preablation imaging should be recommended to avoid rare, but potentially life-threatening, complications with the aim of an as well tolerated as possible procedure.
aDivision of Cardiology, Department of Medical Sciences, University of Torino, 'Città della Salute e della Scienza' Hospital, Turin bDepartment of Cardiovascular and Neurological Sciences, University of Cagliari, Cagliari cDivision of Cardiology, Policlinico Casilino, ASL, Rome, Italy.
Matteo
M
Anselmino
Federica
F
Torri
Federico
F
Ferraris
Leonardo
L
Calò
Davide
D
Castagno
Sebastiano
S
Gili
Chiara
C
Rovera
Carla
C
Giustetto
Fiorenzo
F
Gaita
D000368:Aged; D059925:Anatomic Landmarks; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome