Key Points
- To evaluate the three-dimensional ostial and antral geometry of the pulmonary veins to determine sizing and feasibility requirements for balloon catheter-based ablation.
- Analyzed contrast-enhanced cardiac MRI datasets from N=101 patients with paroxysmal atrial fibrillation.
- Reconstructed 3D endoluminal and external surface models of the left atrium and pulmonary veins to measure ostial circumferences and branching distances.
- A common left ostium was present in 94 patients (circumference 95 ± 15 mm), while individual LSPV, LIPV, RSPV, and RIPV circumferences averaged 67 ± 12 mm, 58 ± 9 mm, 68 ± 11 mm, and 66 ± 11 mm, respectively.
- To achieve 95% anatomical isolation, estimated minimum balloon diameters are 29 mm (RSPV), 28 mm (RIPV), 29 mm (LSPV), 24 mm (LIPV), 40 mm (common left ostium), 46 mm (left antrum), and 47 mm (right antrum).
Structured PICO
PPopulation101 patients with paroxysmal atrial fibrillation
IIntervention3D surface reconstructions of left atrial-pulmonary veins (LA-PVs) using MRI datasets
OOutcomePulmonary vein ostial and antral architecture and size (circumferences and minimal balloon diameters)surrogate
3D anatomical analysis of pulmonary veins indicates that balloon catheter-based ablation is feasible for individual veins but problematic for common PV antra due to large required balloon sizes.