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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

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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.

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Acknowledgments

We are grateful to the staffs of our electrophysiology laboratory for their support to this study.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yu-Der Road, North District, Taichung, 40447, Taiwan

    Jan-Yow Chen & Kuan-Cheng Chang

  2. School of Medicine, China Medical University, Taichung, Taiwan

    Jan-Yow Chen & Kuan-Cheng Chang

  3. Department of Applied Mathematics and Institute of Statistics, National Chung Hsing University, Taichung, Taiwan

    Hong-Dar Isaac Wu

Authors
  1. Jan-Yow Chen
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  3. Kuan-Cheng Chang
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Correspondence to Kuan-Cheng Chang.

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The protocol of the present study was approved by the Institutional Review Board of China Medical University Hospital in Taiwan. The investigation conformed to the principles outlined in the Declaration of Helsinki.

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Chen, JY., Wu, HD.I. & Chang, KC. Pulmonary vein volume and myocardial sleeve extension estimated by 3D computed tomography and voltage mapping predict arrhythmogenic triggers of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 62, 177–185 (2021). https://doi.org/10.1007/s10840-020-00892-x

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  • DOI: https://doi.org/10.1007/s10840-020-00892-x

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