Pre-procedural MCTC can identify left atrial diverticulums, an anatomical variant that poses risks of catheter entrapment and wall penetration during atrial fibrillation ablation.
Alerts operators to left atrial diverticula as a potential ablation risk on MCTC; leaves open systematic assessment of prevalence and complications.
Current image technology with multidetector computed tomography (MCTC) allows the knowledge of anatomical details of structures completely unknown until recently. We describe two patients with left atrium (LA) diverticulums accidentally found in MCTC. The report of this anatomical characteristic is important because LA diverticulums may derive complications in atrial fibrillation (AF) catheter ablation, such as catheter trap and wall penetration. Patient A was a hypertensive 72-year-old man with left bundle branch block and atypical chest pain. The MCTC showed mild coronary lesions and a diverticulum depicted as a bi-lobulated structure of 10 × 6 mm size and a 4 mm mouth. It was situated in the anterosuperior wall of the LA, very close to the opening of the right superior pulmonary veins (Panel A). Patient B was an 82-year-old asymptomatic man with diabetes mellitus and regional wall motion abnormalities. The MCTC revealed a myocardial bridge of a marginal branch of the circumflex coronary artery and a diverticulum of 7 × 6 mm with a 3 mm mouth located in the posteroinferior LA, close to the interatrial septum and the limbus of the fossa ovalis (Panel B).
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Gonçalves et al. (2009) studied this question.
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