Skip to main content
Log in

Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The number of catheter ablations performed for atrial fibrillation (AF) has increased dramatically over the past several years. Regional variation in left atrial (LA) wall thickness is known to exist but have not been described in detail. AF ablation success and complication rates may be related to regional differences in LA wall thickness.

Objective

To evaluate differences in transmural wall thickness in five pre-defined anatomic areas within the LA which are commonly targeted for AF ablation.

Materials and methods

We measured LA wall transmural thickness in 34 human heart specimens using calipers in five anatomic areas frequently targeted during AF ablation (anterior wall, septum, mitral isthmus, posterior wall and roof).

Results

The autopsied individuals were 53% female, 67.7% had CAD, 14.7% had atrial fibrillation, 61.8% had hypertension, and 21.6% had congestive heart failure. The roof was the thinnest region with mean thickness measuring significantly less than each other area (p 0.005 for the posterior wall and <0.001 for all other areas). The septum was the thickest region with mean thickness measuring significantly greater than each other area (p = 0.05, 0.001, <0.001, <0.001 measured against the anterior wall, isthmus, posterior wall and roof, respectively).

Conclusions

Significant regional differences exist for mean left atrial wall thickness among the different anatomic areas within the left atrium which are often targeted during catheter ablation of AF. These differences may have significant implications in determining the ideal intensity and total duration of radiofrequency energy required to achieve a safe and successful ablation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., et al. (2005). Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation, 111, 1100–1105.

    Article  PubMed  Google Scholar 

  2. Haissagurre, M., Jais, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine, 339, 659–666.

    Article  Google Scholar 

  3. Cox, J. L., Schuessler, R. B., & Boineau, J. P. (2000). The development of the maze procedure for the treatment of atrial fibrillation. Seminars in Thoracic and Cardiovascular Surgery, 12, 2–14.

    Article  PubMed  CAS  Google Scholar 

  4. Cox, J. L. (2004). Surgical treatment of atrial fibrillation: A review. Europace, 5, s20–s29.

    Article  PubMed  Google Scholar 

  5. Khargi, K., Hutten, A. B., Lemke, B., & Deneke, T. (2005). Surgical treatment of atrial fibrillation; a systematic review. European Journal of Cardio-thoracic Surgery, 27, 258–265.

    Article  PubMed  Google Scholar 

  6. Pappone, C., Oreto, G., Lamberti, F., Vicedomini, G., Loricchio, M. L., Shpun, S., et al. (1999). Catheter ablation of paroxysmal atrial fibrillation using a 3D mapping system. Circulation, 100, 1203–1208.

    PubMed  CAS  Google Scholar 

  7. Jais, P., Shah, D. C., Haissaguerre, M., Takahashi, A., Lavergne, T., Hocini, M., et al. (1999). Efficacy and safety of septal and left-atrial linear ablation for atrial fibrillation. American Journal of Cardiology, 84, 139R–146R.

    Article  PubMed  CAS  Google Scholar 

  8. Oral, H., Scharf, C., Chugh, A., Hall, B., Cheung, P., Good, E., et al. (2003). Catheter ablation for paroxysmal atrial fibrillation: Segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation, 108, 2355–2360.

    Article  PubMed  Google Scholar 

  9. Pappone, C., Rosanio, S., Augello, G., Gallus, G., Vicedomini, G., Mazzone, P., et al. (2003). Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: Outcomes from a controlled nonrandomized long-term study. Journal of the American College of Cardiology, 42, 185–197.

    Article  PubMed  Google Scholar 

  10. Sanders, P., Jais, P., Hocini, M., Hsu, L. F., Scavée, C., Sacher, F., et al. (2004). Electrophysiologic and clinical consequences of linear catheter ablation to transect the anterior left atrium in patient with atrial fibrillation. Heart Rhythm, 1, 176–184.

    Article  PubMed  Google Scholar 

  11. Becker, A. E. (2004). Left atrial isthmus: Anatomic aspects relevant for linear catheter ablation procedures in humans. Journal of Cardiovascular Electrophysiology, 15, 809–812.

    Article  PubMed  Google Scholar 

  12. Sánchez-Quintana, D., Cabrera, J. A., Climent, V., Farré, J., De Mendonça, M. C., & Ho, S. Y. (2005). Anatomic relations between the esophagus and left atrium and relevance for ablation of atrial fibrillation. Circulation, 112(10), 1400–1405.

    Article  PubMed  Google Scholar 

  13. Lin, W. S., Tai, C. T., Hsieh, M. H., Tsai, C. F., Lin, Y. K., Tsao, H. M., et al. (2003). Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation, 107, 3176–3183.

    Article  PubMed  Google Scholar 

  14. Oral, H., Pappone, C., Chugh, A., Good, E., Bogun, F., Pelosi, F., et al. (2006). Circumferential pulmonary-vein ablation for chronic atrial fibrillation. New England Journal of Medicine, 354, 934–941.

    Article  PubMed  CAS  Google Scholar 

  15. Pappone, C. APAF trial. ACC 2006 Scientific Session.

  16. Pappone, C., Oral, H., Santinelli, V., Vicedomini, G., Lang, C. C., Manguso, F., et al. (2004). Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation, 109, 2724–2726.

    Article  PubMed  Google Scholar 

  17. Doll, N., Borger, M. A., Fabricius, A., Stephan, S., Gummert, J., Mohr, F. W., et al. (2003). Esophageal perforation during left atrial radiofrequency ablation: Is the risk too high? Journal of Thoracic and Cardiovascular Surgery, 125, 836–842.

    Article  PubMed  Google Scholar 

  18. Gillinov, A. M., Pettersson, G., & Rice, T. W. (2001). Esophageal injury during radiofrequency ablation for atrial fibrillation. Journal of Thoracic and Cardiovascular Surgery, 122, 1239–1240.

    Article  PubMed  CAS  Google Scholar 

  19. Sonmez, B., Demirsoy, E., Yagan, N., Unal, M., Arbatli, H., Sener, D., et al. (2003). A fatal complication due to radiofrequency ablation for atrial fibrillation: Atrio-esophageal fistula. Annals of Thoracic Surgery, 76, 281–283.

    Article  PubMed  Google Scholar 

  20. Scanavacca, M. I., Dávila, A., Parga, J., & Sosa, E. (2004). Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 15, 960–962.

    Article  PubMed  Google Scholar 

  21. Ho, S. Y., Sanchez-Qiuntana, D., Cabrera, J. A., & Anderson, R. H. (1999). Anatomy of left atrium: Implications for radiofrequency ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 10(11), 1525–1533.

    PubMed  CAS  Google Scholar 

  22. Lemola, K., Sneider, M., Desjardins, B., Case, I., Han, J., Good, E., et al. (2004). Computed tomographic analysis of the anatomy of the left atrium and the esophagus: Implications for left atrial catheter ablation. Circulation, 110, 3655–3660.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Burr Hall.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hall, B., Jeevanantham, V., Simon, R. et al. Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation. J Interv Card Electrophysiol 17, 127–132 (2006). https://doi.org/10.1007/s10840-006-9052-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-006-9052-2

Keywords

Navigation