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Atrial Fibrillation: Multi–Detector Row CT of Pulmonary Vein Anatomy prior to Radiofrequency Catheter Ablation—Initial Experience¹

¹ From the Departments of Cardiology (M.R.M.J., J.J.B., E.E.v.d.W., M.J.S.) and Radiology (M.S.D., K.G., H.J.L., A.d.R.), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; and Department of Epidemiology and Statistics, Erasmus Medisch Centrum, Rotterdam, the Netherlands (E.B.). From the 2003 RSNA Scientific Assembly. Received July 3, 2003; revision requested September 25; final revision received May 25, 2004; accepted June 23. Address correspondence to J.J.B. (e-mail: j.j.bax@lumc.nl).

View larger version (37K): [in a new window]   Figure 1. Schematic drawing (left) and maximum intensity projection CT image obtained after injection of intravenous contrast material (right) show the left atrium (LA) and right pulmonary veins in the transverse plane to demonstrate the application of definitions. The dotted lines represent the extrapolated border of the left atrium. If the distance between this virtual border and the bifurcation of both pulmonary veins (arrows) is 0.5 cm or larger, as in this example, the ostium of both pulmonary veins is a common ostium because both veins enter the border of the left atrium trough a common trunk. RIPV = right inferior pulmonary vein, RSPV = right superior pulmonary vein.

View larger version (106K): [in a new window]   Figure 2a. CT images. (a, b) Sagittal views illustrate separate insertion of the left pulmonary veins; arrows show veins entering the left atrium separately. (c) Posterior three-dimensional reconstruction for which the descending aorta and spine were removed by segmentation to increase visualization. The left pulmonary veins insert into the left atrium via separate ostia (arrows). LA = left atrium.

View larger version (109K): [in a new window]   Figure 2b. CT images. (a, b) Sagittal views illustrate separate insertion of the left pulmonary veins; arrows show veins entering the left atrium separately. (c) Posterior three-dimensional reconstruction for which the descending aorta and spine were removed by segmentation to increase visualization. The left pulmonary veins insert into the left atrium via separate ostia (arrows). LA = left atrium.

View larger version (94K): [in a new window]   Figure 2c. CT images. (a, b) Sagittal views illustrate separate insertion of the left pulmonary veins; arrows show veins entering the left atrium separately. (c) Posterior three-dimensional reconstruction for which the descending aorta and spine were removed by segmentation to increase visualization. The left pulmonary veins insert into the left atrium via separate ostia (arrows). LA = left atrium.

View larger version (83K): [in a new window]   Figure 3a. CT images. (a, b) Coronal maximum intensity projections show three right pulmonary veins (arrows). (c) Posterior three-dimensional reconstruction. Arrows show the three right pulmonary veins. LA = left atrium.

View larger version (85K): [in a new window]   Figure 3b. CT images. (a, b) Coronal maximum intensity projections show three right pulmonary veins (arrows). (c) Posterior three-dimensional reconstruction. Arrows show the three right pulmonary veins. LA = left atrium.

View larger version (123K): [in a new window]   Figure 3c. CT images. (a, b) Coronal maximum intensity projections show three right pulmonary veins (arrows). (c) Posterior three-dimensional reconstruction. Arrows show the three right pulmonary veins. LA = left atrium.

View larger version (93K): [in a new window]   Figure 4a. Sagittal CT images demonstrate a common ostium of the left pulmonary veins, and solid arrows show the left superior and inferior pulmonary veins. (a) Left superior and inferior pulmonary veins approach the left atrium (LA) separately. (b) Left superior and inferior veins unite before entering the left atrium. (c, d) Veins enter the left atrium through the same ostium (open arrow).

View larger version (94K): [in a new window]   Figure 4b. Sagittal CT images demonstrate a common ostium of the left pulmonary veins, and solid arrows show the left superior and inferior pulmonary veins. (a) Left superior and inferior pulmonary veins approach the left atrium (LA) separately. (b) Left superior and inferior veins unite before entering the left atrium. (c, d) Veins enter the left atrium through the same ostium (open arrow).

View larger version (94K): [in a new window]   Figure 4c. Sagittal CT images demonstrate a common ostium of the left pulmonary veins, and solid arrows show the left superior and inferior pulmonary veins. (a) Left superior and inferior pulmonary veins approach the left atrium (LA) separately. (b) Left superior and inferior veins unite before entering the left atrium. (c, d) Veins enter the left atrium through the same ostium (open arrow).

View larger version (92K): [in a new window]   Figure 4d. Sagittal CT images demonstrate a common ostium of the left pulmonary veins, and solid arrows show the left superior and inferior pulmonary veins. (a) Left superior and inferior pulmonary veins approach the left atrium (LA) separately. (b) Left superior and inferior veins unite before entering the left atrium. (c, d) Veins enter the left atrium through the same ostium (open arrow).

View larger version (105K): [in a new window]   Figure 5a. (a, b) Posterior three-dimensional reconstructed CT images show examples of common ostia of the left pulmonary veins. To facilitate interpretation, the extrapolated border of the left atrium is depicted as a dotted line. (a) Arrow shows the left ventricular apex. (b) The ostium is funnel shaped.

View larger version (101K): [in a new window]   Figure 5b. (a, b) Posterior three-dimensional reconstructed CT images show examples of common ostia of the left pulmonary veins. To facilitate interpretation, the extrapolated border of the left atrium is depicted as a dotted line. (a) Arrow shows the left ventricular apex. (b) The ostium is funnel shaped.