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Changes of Pulmonary Vein Orifice Size and Location throughout the Cardiac Cycle: Dynamic Analysis Using Magnetic Resonance Cine Imaging
Author(s) -
LICKFETT LARS,
DICKFELD TIMM,
KATO RITSUSHI,
TANDRI HARIKRISHNA,
VASAMREDDY CHANDRASEKHAR R.,
BERGER RONALD,
BLUEMKE DAVID,
LÜDERITZ BERNDT,
HALPERIN HENRY,
CALKINS HUGH
Publication year - 2005
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2005.40724.x
Subject(s) - medicine , coronal plane , pulmonary vein , body orifice , atrial fibrillation , magnetic resonance imaging , cardiac cycle , radiofrequency ablation , steady state free precession imaging , ablation , nuclear medicine , sagittal plane , diastole , radiology , cardiology , anatomy , blood pressure
Anatomically guided left atrial ablation is used increasingly for treatment of atrial fibrillation (AF). Three‐dimensional mapping systems used for pulmonary veins (PV) encircling ablation procedures anticipate a stable size and position of the PV orifice. The aim of the current study was therefore to analyze changes of PV orifice size and location throughout the cardiac cycle using cine magnetic resonance imaging (MRI). Methods and Results: Twenty‐five healthy volunteers were studied using a 1.5 Tesla MRI system. MR angiograms were acquired with a breath‐hold three‐dimensional fast‐spoiled gradient‐echo imaging (3D FSPGR) sequence in the coronal plane before and after gadolinium injection. Maximum intensity projections and multiplanar reformations were performed to reconstruct images of the PV. Bright blood cine imaging in the axial view was acquired by a steady‐state free precession pulse sequence. Twenty bright blood images were obtained per cardiac cycle. The axial (anterior‐posterior) PV orifice diameter was measured in all 20 images. For analysis of PV movement the location of the orifice posterior edge was plotted on scale paper. PV orifice size depends on the stage of the cardiac cycle with the largest diameter in late atrial diastole and a mean decrease of 32.5% during atrial systole. Location changes of the PV orifice are in the range of up to 7.2 mm and larger in the coronal (lateral‐medial) than in the sagittal (anterior‐posterior) direction. Conclusion: PV orifice size and location is not as stable as anticipated by three‐dimensional mapping systems used for PV encircling left atrial ablation procedures. RF application close to the presumed orifice location should therefore be avoided to minimize the risk of PV stenosis.