Anatomy of the Left Atrium and Pulmonary Veins – Lessons Learned from Novel Imaging Techniques

Abstract

During the last decade, catheter ablation has become a highly effective treatment option for the cure of symptomatic, drug-resistant atrial fibrillation (AF). Despite the diversity of individual ablation strategies, all of them have something in common: the ablation is performed either within or around the ostia of the pulmonary veins (PV). This practice focused the authors’ attention on anatomy of the PVs and the left atrium. Multiple studies have shown that PV anatomy is highly variable, emphasising the need for imaging before or during the procedure. This has resulted in the development of sophisticated image integration strategies that integrate 3-D anatomy obtained by cardiac magnetic resonance imaging (MRI) or computed tomography (CT) with datasets obtained during 3-D intracardiac mapping. This process may even be guided by an intracardiac echocardiography (ICE).