Abstract
The development of radio-frequency ablation for the treatment of atrial fibrillation has led to increased interest in the accurate determination of pulmonary vein anatomy to help plan the procedure and to monitor for postablation stenosis. Contrast-enhanced magnetic resonance angiography readily demonstrates the pulmonary veins and is the method of choice for these required serial imaging studies. In this chapter, we review the techniques for pulmonary vein imaging, normal and variant pulmonary vein anatomy, the utility of imaging prior to and after atrial fibrillation ablation, and congenital pulmonary vein anomalies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Prince MR, Narasimham DL, Stanley JC, et al. Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. Radiology 1995;197:785–792.
Wittkampf FH, Vonken EJ, Derksen R, et al. Pulmonary vein ostium geometry: analysis by magnetic resonance angiography. Circulation 2003;107:21–23.
Hauser TH, Yeon SB, McClennen S, et al. A method for the determination of proximal pulmonary vein size using contrast-enhanced magnetic resonance angiography. J Cardiovasc Magn Reson 2004;6:927–936.
Hauser TH, Yeon SB, McClennen S, et al. Subclinical pulmonary vein narrowing after ablation for atrial fibrillation. Heart 2005;91:672–673.
Mansour M, Holmvang G, Sosnovik D, et al. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J Cardiovasc Electrophysiol 2004;15:387–393.
Mlcochova H, Tintera J, Porod V, Peichl P, Cihak R, Kautzner J. Magnetic resonance angiography of pulmonary veins: implications for catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol 2005;28:1073–1080.
Syed MA, Peters DC, Rashid H, Arai AE. Pulmonary vein imaging: comparison of 3D magnetic resonance angiography with 2D cine MRI for characterizing anatomy and size. J Cardiovasc Magn Reson 2005;7:355–360.
Tamborero D, Mont L, Nava S, et al. Incidence of pulmonary vein stenosis in patients submitted to atrial fibrillation ablation: a comparison of the selective segmental ostial ablation vs the circumferential pulmonary veins ablation. J Interv Card Electrophysiol 2005;14:21–25.
Tsao HM, Wu MH, Huang BH, et al. Morphologic remodeling of pulmonary veins and left atrium after catheter ablation of atrial fibrillation: insight from long-term follow-up of three-dimensional magnetic resonance imaging. J Cardiovasc Electrophysiol 2005;16:7–12.
Vonken EP, Velthuis BK, Wittkampf FH, Rensing BJ, Derksen R, Cramer MJ. Contrast-enhanced MRA and 3D visualization of pulmonary venous anatomy to assist radiofrequency catheter ablation. J Cardiovasc Magn Reson 2003;5:545–551.
Lickfett L, Dickfeld T, Kato R, et al. Changes of pulmonary vein orifice size and location throughout the cardiac cycle: dynamic analysis using magnetic resonance cine imaging. J Cardiovasc Electrophysiol 2005;16:582–588.
Hauser TH, Yeon SB, McClennen S, et al. Variability in pulmonary vein anatomy during the cardiac cycle. Society for Cardiovascular Magnetic Resonance; 2005.
Schoenberg SO, Bock M, Floemer F, et al. High-resolution pulmonary arterio-and venography using multiple-bolus multiphase 3D-Gd-mRA. J Magn Reson Imaging 1999;10:339–346.
Earls JP, Rofsky NM, DeCorato DR, Krinsky GA, Weinreb JC. Breath-hold single-dose gadolinium-enhanced three-dimensional MR aortography: usefulness of a timing examination and MR power injector. Radiology 1996;201:705–710.
Wilman AH, Riederer SJ, King BF, Debbins JP, Rossman PJ, Ehman RL. Fluoroscopically triggered contrast-enhanced three-dimensional MR angiography with elliptical centric view order: application to the renal arteries. Radiology 1997;205:137–146.
Blom NA, Gittenberger-de Groot AC, Jongeneel TH, DeRuiter MC, Poelmann RE, Ottenkamp J. Normal development of the pulmonary veins in human embryos and formulation of a morphogenetic concept for sinus venosus defects. Am J Cardiol 2001;87:305–309.
Moore KL. The developing human. Philadelphia: Saunders; 1988.
Webb S, Kanani M, Anderson RH, Richardson MK, Brown NA. Development of the human pulmonary vein and its incorporation in the morphologically left atrium. Cardiol Young 2001;11:632–642.
Kato R, Lickfett L, Meininger G, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation 2003;107:2004–2010.
Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med 1995;155:469–473.
Heart disease and strokestatistics—2004 Update. Dallas, TX: American Heart Association.
Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946–952.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983–988.
Hauser TH, Pinto DS, Josephson ME, Zimetbaum P. Early recurrence of arrhythmia in patients taking amiodarone or class 1C agents for treatment of atrial fibrillation or atrial flutter. Am J Cardiol 2004;93:1173–1176.
Singh BN, Singh SN, Reda DJ, et al. Amiodarone vs sotalol for atrial fibrillation. N Engl J Med 2005;352:1861–1872.
Roy D, Talajic M, Dorian P, et al. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med 2000;342:913–920.
Hauser TH, Pinto DS, Josephson ME, Zimetbaum P. Safety and feasibility of a clinical pathway for the outpatient initiation of antiarrhythmic medications in patients with atrial fibrillation or atrial flutter. Am J Cardiol 2003;91:1437–1441.
Hassink RJ, Aretz HT, Ruskin J, Keane D. Morphology of atrial myocardium in human pulmonary veins: a postmortem analysis in patients with and without atrial fibrillation. J Am Coll Cardiol 2003;42:1108–1114.
Arora R, Verheule S, Scott L, et al. Arrhythmogenic substrate of the pulmonary veins assessed by high-resolution optical mapping. Circulation 2003;107:1816–1821.
Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659–666.
Pappone C, Rosanio S, Oreto G, et al. Circumferential radiofrequency ablation of pulmonary vein ostia. A new anatomic approach for curing atrial fibrillation. Circulation 2000;102:2619–2628.
Arentz T, von Rosenthal J, Blum T, et al. Feasibility and safety of pulmonary vein isolation using a new mapping and navigation system in patients with refractory atrial fibrillation. Circulation 2003;108:2484–2490.
Haissaguerre M, Jais P, Shah DC, et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000;101:1409–1417.
Oral H, Knight BP, Ozaydin M, et al. Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights. Circulation 2002;106:1256–1262.
Pappone C, Rosanio S, Augello G, et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 2003;42:185–197.
Marine JE, Dong J, Calkins H. Catheter ablation therapy for atrial fibrillation. Prog Cardiovasc Dis 2005;48:178–192.
Lin WS, Prakash VS, Tai CT, et al. Pulmonary vein morphology in patients with paroxysmal atrial fibrillation initiated by ectopic beats originating from the pulmonary veins: implications for catheter ablation. Circulation 2000;101:1274–1281.
Calkins H. Three dimensional mapping of atrial fibrillation: techniques and necessity. J Interv Card Electrophysiol 2005;13(suppl 1):53–59.
Scanavacca MI, D’Avila A, Parga J, Sosa E. Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2004;15:960–962.
Pappone C, Oral H, Santinelli V, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation 2004;109:2724–2726.
Cummings JE, Schweikert RA, Saliba WI, et al. Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium. Circulation 2005;112:459–464.
Redfearn DP, Trim GM, Skanes AC, et al. Esophageal temperature monitoring during radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2005;16:589–593.
Lemola K, Sneider M, Desjardins B, et al. Computed tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation 2004;110:3655–3660.
Tsao HM, Wu MH, Higa S, et al. Anatomic relationship of the esophagus and left atrium: implication for catheter ablation of atrial fibrillation. Chest 2005;128:2581–2587.
Cury RC, Abbara S, Schmidt S, et al. Relationship of the esophagus and aorta to the left atrium and pulmonary veins: Implications for catheter ablation of atrial fibrillation. Heart Rhythm 2005;2:1317–1323.
Sanchez-Quintana D, Cabrera JA, Climent V, Farre J, Mendonca MC, Ho SY. Anatomic relations between the esophagus and left atrium and relevance for ablation of atrial fibrillation. Circulation 2005;112:1400–1405.
Monnig G, Wessling J, Juergens KU, et al. Further evidence of a close anatomical relation between the oesophagus and pulmonary veins. Europace 2005;7:540–545.
Good E, Oral H, Lemola K, et al. Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. J Am Coll Cardiol 2005;46:2107–2110.
Moak J, Moore H, Lee S, et al. Case report: pulmonary vein stenosis following RF ablation of paroxysmal atrial fibrillation: successful treatment with balloon dilation. J Interv Card Electrophysiol 2000;4:621–631.
Saad EB, Rossillo A, Saad CP, et al. Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation 2003;108:3102–3107.
Saad EB, Marrouche NF, Saad CP, et al. Pulmonary vein stenosis after catheter ablation of atrial fibrillation: emergence of a new clinical syndrome. Ann Intern Med 2003;138:634–638.
Scanvacca M, Kajita L, Vieira M, Sosa E. Pulmonary vein stenosis complicating catheter ablation of focal atrial fibrillation. J Cardiovasc Electrophysiol 2000;1:677–681.
Yang M, Akbari H, Reddy GP, Higgins CB. Identification of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation using MRI. J Comput Assist Tomogr 2001;25:34–35.
Arentz T, Jander N, von Rosenthal J, et al. Incidence of pulmonary vein stenosis 2 years after radiofrequency catheter ablation of refractory atrial fibrillation. Eur Heart J 2003;24:963–969.
Dill T, Neumann T, Ekinci O, et al. Pulmonary vein diameter reduction after radiofrequency catheter ablation for paroxysmal atrial fibrillation evaluated by contrast-enhanced three-dimensional magnetic resonance imaging. Circulation 2003;107:845–850.
Taylor GW, Kay GN, Zheng X, Bishop S, Ideker RE. Pathological effects of extensive radiofrequency energy applications in the pulmonary veins in dogs. Circulation 2000;101:1736–1742.
Kluge A, Dill T, Ekinci O, et al. Decreased pulmonary perfusion in pulmonary vein stenosis after radiofrequency ablation: assessment with dynamic magnetic resonance perfusion imaging. Chest 2004;126:428–437.
Arentz T, Weber R, Jander N, et al. Pulmonary haemodynamics at rest and during exercise in patients with significant pulmonary vein stenosis after radiofrequency catheter ablation for drug resistant atrial fibrillation. Eur Heart J 2005;26:1410–1414.
Qureshi AM, Prieto LR, Latson LA, et al. Transcatheter angioplasty for acquired pulmonary vein stenosis after radiofrequency ablation. Circulation 2003;108:1336–1342.
Bowman AW, Kovacs SJ. Prediction and assessment of the time-varying effective pulmonary vein area via cardiac MRI and Doppler echocardiography. Am J Physiol Heart Circ Physiol 2005;288:H280–H286.
Wood MA, Wittkamp M, Henry D, et al. A comparison of pulmonary vein ostial anatomy by computerized tomography, echocardiography, and venography in patients with atrial fibrillation having radiofrequency catheter ablation. Am J Cardiol 2004;93:49–53.
Hauser TH, Essebag V, Baldessin F, et al. Larger pulmonary vein cross-sectional area is associated with recurrent atrial fibrillation after pulmonary vein isolation. Circulation 2005;112(S):II-555.
Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000;343:1445–1453.
Simonetti OP, Kim RJ, Fieno DS, et al. An improved MR imaging technique for the visualization of myocardial infarction. Radiology 2001;218:215–223.
Judd RM, Lugo-Olivieri CH, Arai M, et al. Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of 2-days-old reperfused canine infarcts. Circulation 1995;92:1902–1910.
Peters DC, Wylie JV, Kissinger KV, et al. Detection of pulmonary vein ablation with high resolution MRI. Society for Cardiovascular Magnetic Resonance; 2006.
Krabill KA, Lucas RV. Abnormal pulmonary venous connections. In: Emmanouilides GC, Riemenschneider TA, Allen HD, et al., eds. Moss and Adams’ heart disease in infants, children and adolescents. Baltimore, MD: Williams and Wilkins; 1995:838.
Friedman WF, Silverman N. Congenital heart disease in infancy and childhood. In: Braunwald E, Zipes DP, Libby P, eds. Heart disease. Philadelphia: Saunders; 2001:1552.
Wang JK, Lue HC, Wu MH, Young ML, Wu FF, Wu JM. Obstructed total anomalous pulmonary venous connection. Pediatr Cardiol 1993;14:28–32.
Ward KE, Mullins CE, Huhta JC, Nihill MR, McNamara DG, Cooley DA. Restrictive interatrial communication in total anomalous pulmonary venous connection. Am J Cardiol 1986;57:1131–1136.
Lamb RK, Qureshi SA, Wilkinson JL, Arnold R, West CR, Hamilton DI. Total anomalous pulmonary venous drainage. Seventeen-year surgical experience. J Thorac Cardiovasc Surg 1988;96:368–375.
Gao YA, Burrows PE, Benson LN, Rabinovitch M, Freedom RM. Scimitar syndrome in infancy. J Am Coll Cardiol 1993;22:873–882.
Greil G, Powell A, Gildein H, Geva T. Gadolinium-enhanced three-dimensional magnetic resonance aniography of pulmonary and systemic venous anomalies. J Am Coll Cardiol 2002;39:335–341.
Ghaye B, Szapiro D, Dacher J, Rodriguez L, Timmermans C, Devillers D, Dondelinger R. Percutaneous ablation for arrial fibrillation: the role of cross-sectional imaging. Radiographics 2003;23:19S.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Hauser, T.H., Peters, D.C. (2008). Assessment of Pulmonary Venous Anatomy. In: Kwong, R.Y. (eds) Cardiovascular Magnetic Resonance Imaging. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-306-6_27
Download citation
DOI: https://doi.org/10.1007/978-1-59745-306-6_27
Publisher Name: Humana Press
Print ISBN: 978-1-58829-673-3
Online ISBN: 978-1-59745-306-6
eBook Packages: MedicineMedicine (R0)