Topographic variability of the left atrium and pulmonary veins assessed by 3D-CT predicts the recurrence of atrial fibrillation after catheter ablation

Kunihiko Kiuchi, MD; Akihiro Yoshida, MD; Asumi Takei, MD; Koji Fukuzawa, MD; Mitsuaki Itoh, MD; Kimitake Imamura, MD; Ryudo Fujiwara, MD; Atsushi Suzuki, MD; Tomoyuki Nakanishi, MD; Soichiro Yamashita, MD; Ken-ichi Hirata, MD; Gaku Kanda, MD; Katsunori Okajima, MD; Akira Shimane, MD; Shinichiro Yamada, MD; Yasuyo Taniguchi, MD; Yoshinori Yasaka, MD; Hiroya Kawai, MD

doi:10.1016/j.joa.2015.03.006

Journal of Arrhythmia (Oct 2015)

Topographic variability of the left atrium and pulmonary veins assessed by 3D-CT predicts the recurrence of atrial fibrillation after catheter ablation

Kunihiko Kiuchi, MD,
Akihiro Yoshida, MD,
Asumi Takei, MD,
Koji Fukuzawa, MD,
Mitsuaki Itoh, MD,
Kimitake Imamura, MD,
Ryudo Fujiwara, MD,
Atsushi Suzuki, MD,
Tomoyuki Nakanishi, MD,
Soichiro Yamashita, MD,
Ken-ichi Hirata, MD,
Gaku Kanda, MD,
Katsunori Okajima, MD,
Akira Shimane, MD,
Shinichiro Yamada, MD,
Yasuyo Taniguchi, MD,
Yoshinori Yasaka, MD,
Hiroya Kawai, MD

Affiliations

Kunihiko Kiuchi, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Akihiro Yoshida, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Asumi Takei, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Koji Fukuzawa, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Mitsuaki Itoh, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Kimitake Imamura, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Ryudo Fujiwara, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Atsushi Suzuki, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Tomoyuki Nakanishi, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Soichiro Yamashita, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Ken-ichi Hirata, MD: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku Kobe, Hyogo, Japan
Gaku Kanda, MD: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
Katsunori Okajima, MD: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
Akira Shimane, MD: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
Shinichiro Yamada, MD: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
Yasuyo Taniguchi, MD: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
Yoshinori Yasaka, MD: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan
Hiroya Kawai, MD: Department of Cardiology, Himeji Cardiovascular Center, 520 kou saishou, Himeji, Hyogo, Japan

DOI: https://doi.org/10.1016/j.joa.2015.03.006
Journal volume & issue: Vol. 31, no. 5
pp. 286 – 292

Abstract

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Background: Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). However, the assessment of anatomical information and predictors of AF recurrence remain unclear. We investigated the relationship between anatomical information on the left atrium (LA) and pulmonary veins (PVs) from three-dimensional computed tomography images and the recurrence of AF after CA. Methods: Sixty-seven consecutive AF patients (mean age: 62±10 years, median AF history: 42 (12; 60) months, mean LA size: 41±7 mm, paroxysmal: 56%) underwent CA and were followed for 19±10 months. The segmented surface areas (antral, posterior, septal, and lateral) and dimensions (between the anterior and posterior walls, the right inferior PV and mitral annulus [MA], the right superior PV and MA, the left superior PV and MA, and the mitral isthmus) of the LA were evaluated three dimensionally using the NavX system. The cross-sectional areas of the PVs were also evaluated. Results: After the follow-up period, 49 patients (73%) remained free from AF. A multivariate analysis showed that the diameter of the mitral isthmus and cross-sectional area of the right upper PV were associated with AF recurrence (odds ratio: 1.070, CI: 1.02–1.12, p=0.001; odds ratio: 0.41, CI: 0.21–0.77, p=0.006). Conclusion: Enlargement of the mitral isthmus and a smaller right superior PV cross-sectional area were associated with AF recurrence.

Published in Journal of Arrhythmia

ISSN: 1880-4276 (Print); 1883-2148 (Online)
Publisher: Wiley
Country of publisher: Australia
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://onlinelibrary.wiley.com/journal/18832148

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