Pulmonary vein volume and myocardial sleeve extension estimated by 3D computed tomography and voltage mapping predict ar
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Pulmonary vein volume and myocardial sleeve extension estimated by 3D computed tomography and voltage mapping predict arrhythmogenic triggers of paroxysmal atrial fibrillation Jan-Yow Chen 1,2
&
Hong-Dar Isaac Wu 3 & Kuan-Cheng Chang 1,2
Received: 26 June 2020 / Accepted: 28 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Relationship between pulmonary vein (PV) anatomy and the pathophysiology of paroxysmal atrial fibrillation (PAF) remains incompletely studied. The aim of this study was to determine whether PV anatomy predicts arrhythmogenic PVs. Methods Twenty-six consecutive PAF patients with spontaneous PAF or consistently frequent ectopic beats during electrophysiological study were enrolled. Computed tomography (CT) images for PVs were reconstructed into 3D images. The PV diameter and volume were measured based on the 3D images. The PV myocardial sleeve area was measured based on the 3D voltage mapping results. The PV myocardial sleeve area index was calculated by dividing the sleeve area of each PV by the average sleeve area of all PVs in each patient. Results The diameter and volume of the arrhythmogenic PVs were larger than those of the non-arrhythmogenic PVs (21.08 ± 4.57 mm vs. 16.47 ± 3.31 mm, P < 0.001 and 7.70 ± 3.28 cm3 vs. 4.09 ± 1.99 cm3, P < 0.001, respectively). The myocardial sleeve area and sleeve area index of the arrhythmogenic PVs were also larger than those of the non-arrhythmogenic PVs (8.62 ± 5.33 cm2 vs. 4.77 ± 3.84 cm2, P < 0.001 and 1.59 ± 0.35 vs. 0.81 ± 0.38, P < 0.001, respectively). Multivariate analysis showed the PV myocardial sleeve area index was the independent predictor for arrhythmogenic PVs (P < 0.001). Conclusions PV size plays an important role in triggering PAF. A large myocardial sleeve extension is a powerful and independent predictor for arrhythmogenic PV, which may be useful anatomical markers to facilitate PAF ablation. Keywords Paroxysmal atrial fibrillation . Pulmonary vein . Computed tomography . 3D mapping
1 Introduction Paroxysmal atrial fibrillation (PAF) was considered to be primarily initiated by triggers via the arrhythmogenic pulmonary vein (PV). An effective strategy for curative treatment of PAF is ablation therapy, which isolates the arrhythmogenic PV. However, methods for recognizing the arrhythmogenic PV have not been well-studied. In addition, the impact of PV The study has been presented in part in abstract form on the “HRS 2020 Science” sessions of the Heart Rhythm Society in May 2020. * Kuan-Cheng Chang [email protected] 1
Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yu-Der Road, North District, Taichung 40447, Taiwan
2
School of Medicine, China Medical University, Taichung, Taiwan
3
Department of Applied Mathematics and Institute of Statistics, National Chung Hsing University, Taichung, Taiwan
anatomy and myocardial sleeve architecture in triggering PAF was still unclear. The relationship between PV size and the arrhythmog
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