Pulmonary vein variants predispose to atrial fibrillation: A case-control study using multislice contrast-enhanced computed tomography

Abstract

Aims: : Pulmonary veins (PV) play a pivotal role in atrial fibrillation (AF). Anatomical variants of PV have been described and related to a higher arrhythmogenic potential. The aim of this study was to compare the prevalence of PV variants and diameters of PV ostia in AF patients and controls. Methods and results: : Variants of PV were defined as right or left common ostia (RCO, LCO), a right middle or right top PV. A long common trunk (LCT) was defined as an LCO with a distance to the first branching <10 mm. Multislice contrast-enhanced thoracic computed tomography was performed prior to AF ablation in 166 consecutive patients, 47.6 with paroxysmal, 52.4 with persistent AF, as well as in a sex- and age-matched control group without AF, for non-cardiological indications. Images were evaluated by two independent observers. The mean age was 59 ± 10 years, 108 were men (65.1). A higher prevalence of LCO was found in the AF group: 33.7 vs. 19.9 (P 0.004), odds ratio (OR) 2.1; 15.4 in patients vs. 10.2 in controls had an LCT (P 0.14). No differences in other PV variants were found. The ostial diameters were greater in AF-patients (P< 0.001). Conclusion: s: To the best of our knowledge, the present study shows for the first time a higher prevalence of an LCO in patients with AF as compared with controls, with an OR of 2.1. This suggests a pre-disposing role of LCO in the development of AF. Published on behalf of the European Society of Cardiology. All rights reserved. © 2011 The Author.