The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation

Figures

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  Fig. 1. Patients with atrial fibrillation were enrolled in the study population, between the time interval of 2019 January to 2020 December who underwent PVI using the CLOSE protocol. After excluding cases with cryoablation, prior PVI and suboptimal CT image quality a total of 94 patients were analysed. AF atrial fibrillation, PVI pulmonary vein isolation

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  Fig. 2. Volume rendered 3D CT images demonstrate the 11 locations where the wall thickness was measured in the left atrium (modified after Hayashi et al. [24]). On A the LA is in a posterior view whereas B represents the left lateral view of the LA. The numbers show the following left atrial areas: 1: right roof. 2: right mid-posterior, 3: right infero-posterior, 4: middle part of the roof, 5: middle part of the mid-posterior, 6: middle part of the infero-posterior, 7: left of the roof, 8: left of the mid-posterior, 9: left of the infero-posterior, 10: mitral isthmus, 11: left lateral ridge. LA left atrium, LIPV left inferior pulmonary vein, LSPV left superior pulmonary vein, RIPV right inferior pulmonary vein, RSPV right superior pulmonary vein

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  Fig. 3. Left atrial wall thickness (LAWT) was measured at 11 sites based on Hayashi et al. as demonstrated on the CT images. The numbers indicate the same locations for LAWT assessment as illustrated in Fig. 2. The dashed squares show the area of interest which are enlarged in the right-hand corner of every image. The blue line between the two dots represents the size of the measured LAWT. The roof and the infero-posterior wall thickness (Number 1, 3, 7 and 9) were assessed at 10 mm distance from the junction of the left atrium and pulmonary vein. LAWT at the ridge was measured at the center of the left superior PV (5 mm from the LA wall). LA left atrium, LAWT left atrial wall thickness, PV pulmonary vein

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  Fig. 4. Volume-rendered images show a typical pulmonary vein anatomy with left inferior and superior pulmonary veins and right inferior and superior pulmonary veins. The red circles represent the area of the ostium of each PVs while the blue arrows the maximum and minimum diameters of the orifices. LIPV left inferior pulmonary vein, LSPV left superior pulmonary vein, RIPV right inferior pulmonary vein, RSPV right superior pulmonary vein

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  Fig. 5. Electroanatomical map of the left atrium after pulmonary vein isolation performed with the modified CLOSE protocol (postero-anterior view). All red ablation tags indicate an ablation index value > 400 on the posterior wall and > 500 on the anterior wall. The inter-tag distance is < 6 mm between all points