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Europace Advance Access originally published online on December 3, 2007
Europace 2008 10(2):218; doi:10.1093/europace/eum260
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

ABLATION FOR ATRIAL FIBRILLATION

Identification of the right middle pulmonary vein ostium by translucent three dimensional image of multi-detector computed tomography

Tetsuya Hara1,2, Kohei Yamashiro1,* {dagger} and Teishi Kajiya1

1 Department of Cardiology, Himeji Cardiovascular Center, 520 Saisho-ko, Himeji, Hyogo 670-0981, Japan; 2 Division of Cardiology, Kobe University, 7-5-2 Kusunokicho, Chuo-ku, Kobe, Hyogo, Japan

Manuscript submitted 11 September 2007. Accepted after revision 6 November 2007.

* Corresponding author. Tel: + 81 532 37 3377; fax: + 81 532 37 3366.E-mail address: kyamashiro{at}heart-center.or.jp

Key Words: Pulmonary vein, Ablation, Translucent, MDCT

A 60-year-old man was hospitalized to receive percutaneous catheter pulmonary vein (PV) isolation for the treatment of drug refractory paroxysmal atrial fibrillation. We constructed a translucent volume-rendering image by multi-detector computed tomography (MDCT) which can clearly delineate the conjugation between PVs and left atrium. This translucent MDCT image can be rotated in anyway so that we can display in the same views of angiography. In the right anterior oblique view, the right inferior PV (RIPV) runs horizontally towards the spine (Figure 1). This translucent image can clearly demonstrate the ostium of RIPV, which could contribute to avoid the delivery of radiofrequency energy deep within the PV, which may lead PV stenosis.


Figure 1
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  		Figure 1 Right anterior oblique views of the translucent image by multi-detector computed tomography (A) and angiography (B) were shown. Arrows indicate the ostium of the right inferior pulmonary vein.

 
Furthermore, the left anterior oblique view of the translucent image could also identify the ostium of both the right middle PV (RMPV) and RIPV like a bull's eye appearance very clearly (Figure 2) which could not be revealed by angiography. Understanding this anatomical characteristic helped us to avoid ablation within the RMPV during the ablation procedure at the carina.


Figure 2
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  		Figure 2 Left anterior oblique views of the translucent image by multi-detector computed tomography (A) and angiography (B) were shown. Arrows indicate the ostium of the right inferior pulmonary vein. Thick arrows indicate the ostium of the left inferior pulmonary vein, and thin arrows indicate the right inferior pulmonary vein. Dotted circle indicates the ostium of the right middle pulmonary vein.

 
The translucent image of MDCT can delineate the conjunction between the PVs and left atrium including left atrial appendage clearly in a 3D image in the same view of angiography, which helps electrophysiologists to imagine an ablation line during PV isolation. In this case, MDCT could clearly demonstrate the ostium of RMPV, which helped us to avoid ablation within PMPV through the ablation procedure at the carina.


   Footnotes
 
{dagger} Present address. Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyama-cho, Toyohashi 441-8530, Japan. Back


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This Article
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10/2/218    most recent
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