Skip to main content
SpringerLink
Log in

Anatomy Assessment for Atrial Arrhythmias

  • Chapter
  • First Online:
Cardiac Imaging in Electrophysiology

  • 2148 Accesses

Abstract

Catheter ablation of atrial arrhythmias has increased dramatically over the past decade, mainly due to an increase in the number of ablation procedures performed for atrial fibrillation, the most common ablation procedure performed worldwide. Given the complexity of the left and right atria as well as the intricacy of ablation procedures for these arrhythmias, knowledge of atrial anatomy and its variants is vital when planning a safe and effective ablation strategy. In this chapter, we will review the role and importance of anatomy assessment including the use of cardiac imaging prior to atrial ablation procedures.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Calkins H. Prevention of esophageal injury during catheter ablation of atrial fibrillation: Is intracardiac echocardiography the answer? Heart Rhythm. 2006;3:1162-1163.

    Article  PubMed  Google Scholar 

  2. Perez FJ, Schubert CM, Parvez B, Pathak V, Ellenbogen KA, Wood MA. Long term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis. Circ Arrhythm Electrophysiol. 2009; Aug 2(4);393-401

    Google Scholar 

  3. Cabrera JA, Sanchez-Quintana D, Farre J, Rubio JM, Ho SY. The inferior right atrial isthmus: further architectural insights for current and coming ablation technologies. J Cardiovasc Electrophysiol. 2005;16:402-408.

    Article  PubMed  Google Scholar 

  4. Nako M, Saoudi N. More on isthmus anatomy for safety and efficacy. J Cardiovasc Electrophysiol. 2005;16:409-410.

    Article  Google Scholar 

  5. Anseleme F, Klug D, Scanu P, et al. Randomized comparison of two targets in typical atrial flutter. Am J Cardiol. 2000;85:1302-1307.

    Article  Google Scholar 

  6. Asirvathnam SJ. Correlative anatomy and electrophysiology for the interventional electrophysiologist: right atrial flutter. J Cardiovasc Electrophysiol. 2009;20:113-122.

    Article  Google Scholar 

  7. Asirvatham S, Friedman P, Packer D, Edwards W. Prevalence of a right atrial pouch and extension of pectinate muscles across the tricuspid valve-IVC isthmus. Circulation. 2001;104:409.

    Google Scholar 

  8. Morton JB, Sanders P, Davidson NC, Sparks PB, Vohra JK, Kalman JK. Phased array intracardiac echocardiography for defining cavotricuspid anatomy during radiofrequency ablation of typical flutter. J Cardiovasc Electrophysiol. 2003;14:591-597.

    Article  PubMed  Google Scholar 

  9. Becker R, Bauer A, Metz S, et al. Intercaval block in normal canine hearts: role of the terminal crest. Circulation. 2001;103:2521-2526.

    PubMed  CAS  Google Scholar 

  10. Okishige K, Kawabata M, Yamashiro K, et al. Clinical study regarding the anatomical structures of the right atrial isthmus using intra-cardiac echocardiography. Implication for catheter ablation of common atrial flutter. J Interv Card Electrophysiol. 2005;12:9-12.

    Article  PubMed  Google Scholar 

  11. DaCosta A, Jamon Y, Romeyer-Bouchard C, Thevenin J, Messier M, Issaz K. Catheter selection for ablation of cavotricuspid isthmus for treatment of typical atrial flutter. J Interv Card Electrophysiol. 2006;17:93-101.

    Article  Google Scholar 

  12. Rodriguez LM, de Chillou C, Schlapfer J, et al. Age at onset and gender of patients with different types of supraventricular tachycardias. Am J Cardiol. 1992;70:1213-1215.

    Article  PubMed  CAS  Google Scholar 

  13. Porter MJ, Morton JB, Denman R, et al. Influence of age and gender on the mechanism of supraventricular tachycardia. Heart Rhythm. 2004;4:393-396.

    Article  Google Scholar 

  14. Kalman JM, Olgin JE, Karch MR, Hamden M, Lee RJ, Lesh MD. “Cristal tachycardias”: origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography. J Am Coll Cardiol. 1998;31:451-459.

    Article  PubMed  CAS  Google Scholar 

  15. Yamashiro K, Ehara M, Ozawa T, Satoh K, Suzuki T. Accuracy of right phrenic nerve image using 64 slice multi-detector computed tomography in patients with atrial fibrillation. J Am Coll Cardiol. 2009;53(suppl):A104.

    Google Scholar 

  16. Horton R, Sanchez J, Hepler E, et al. Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomography. J Am Coll Cardiol. 2009;53(suppl):A107.

    Google Scholar 

  17. Anderson RH, Brown NA. Anatomy of the heart revisited. Anat Rec. 1996;246:1-7.

    Article  PubMed  CAS  Google Scholar 

  18. Thiagalingam A, D’avila A, Foley L, et al. Full-color direct visualization of the atrial septum to guide transseptal puncture. J Cardiovasc Electrophysiol. 2008;19:1310-1315.

    Article  PubMed  Google Scholar 

  19. Kato R, Lickfett L, Meininger GR, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation. Circulation. 2003;107:2004-2010.

    Article  PubMed  Google Scholar 

  20. Saksena S, Sra JS, Jordaens L. Intracardiac Echocardiography-Guided Cardioversion Helps Interventional Procedures (ICE-CHIP) trial. Heart Rhythm Society 2007 Scientific Sessions; Late Breaking Clinical Trials II, May 11, 2007; Denver.

    Google Scholar 

  21. Martinez MW, Kirsch J, Williamson EE, et al. Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation. JACC Cardiovasc Imaging. 2009;2:69-76.

    Article  PubMed  Google Scholar 

  22. Garcia MJ. Detection of left atrial appendage thrombus by cardiac computed tomography. JACC Cardiovasc Imaging. 2009;2:77-79.

    Article  PubMed  Google Scholar 

  23. Iuliano A, Stabile G, De Simone A. Unusual insertion and course of the left atrial appendage: how imaging can guide atrial fibrillation ablation. Europace. 2007;9:643-644.

    Article  PubMed  Google Scholar 

  24. Marom EM, Herndon JE, Kim YH, McAdans HP. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 2004;230:824-829.

    Article  PubMed  Google Scholar 

  25. Ho SY, Cabrera JA, Tran VH, Farre J, Anderson RH, Sanchez-Quintana D. Architecture of the pulmonary veins: relevance to radiofrequency ablation. Heart. 2001;86:265-270.

    Article  PubMed  CAS  Google Scholar 

  26. Mansour M, Refaat M, Heist EK, et al. Three-dimensional anatomy of the left atrium by magnetic resonance angiography: implications for catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17:719-723.

    Article  PubMed  Google Scholar 

  27. McGavigan AD, Kalmann JM. Atrial anatomy and imaging for atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2006;17:S8-S15.

    Article  Google Scholar 

  28. Singh SM, Heist EK, Donaldson D, et al. Image integration using intracardiac ultrasound to guide catheter ablation of atrial fibrillation. Heart Rhythm. 2008;5:1548-1555.

    Article  PubMed  Google Scholar 

  29. Thiagalingam A, Reddy VY, Cury RC, et al. Pulmonary vein contraction: characterization of dynamic changes in pulmonary vein morphology using multiphase multislice computed tomography scanning. Heart Rhythm. 2008;5:1645-1650.

    Article  PubMed  Google Scholar 

  30. Noseworthy PA, Malchano ZJ, Ahmed J, Homvang G, Ruskin JN, Reddy VY. The impact of respiration on left atrial and pulmonary venous anatomy: implications for image-guided intervention. Heart Rhythm. 2005;2:1173-1178.

    Article  PubMed  Google Scholar 

  31. Hall B, Jeevanantham V, Simon R, Filippone J, Vorobiof G, Daubert J. Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation. J Interv Card Electrophysiol. 2006;17:127-132.

    Article  PubMed  Google Scholar 

  32. Platonov PG, Ivanov V, Ho SY, Mitrofanov L. Left atrial posterior wall thickness in patients with and without atrial fibrillation: data from 298 consecutive autopsies. J Cardiovasc Electrophysiol. 2008;19:689-692.

    Article  PubMed  Google Scholar 

  33. Weerasooriya R, Murray C. Left atrial roof pouch. Europace. 2007;9:1141.

    Article  PubMed  Google Scholar 

  34. Wongcharoen W, Tsao H, Wu M, et al. Morphologic characterization of the left atrial appendage, roof and septum: implications for the ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17:951-956.

    Article  PubMed  Google Scholar 

  35. Cummings JE, Schwelkert RA, Salida W, et al. Brief communication: atrial-esophageal fistulas after radiofrequency ablation. Ann Intern Med. 2006;144:572-574.

    PubMed  Google Scholar 

  36. Lemola K, Sneider M, Desjardins B, et al. Computed tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation. 2004;110:3655-3660.

    Article  PubMed  Google Scholar 

  37. Nolker G, Gutleben KJ, Marschang H, et al. Three-dimensional left atrial and esophagus reconstruction using cardiac C-arm computed tomography with image integration into fluoroscopic views for ablation of atrial fibrillation: accuracy of a novel modality in comparison with multislice computed tomography. Heart Rhythm. 2008;5:1651-1657.

    Article  PubMed  Google Scholar 

  38. Singh SM, Doshi SK, Brugge WR, et al. Esophageal injury and temperature monitoring during atrial fibrillation ablation. Circ Arrhythm Electrophysiol. 2008;1:162-168.

    Article  PubMed  Google Scholar 

  39. Helms A, West JJ, Patel A, et al. Real-time rotational ICE imaging of the relationship of the ablation catheter tip and the esophagus during atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2009;20:130-137.

    Article  PubMed  Google Scholar 

  40. Ho I, Heist EK, Aryana A, et al. Compression of the left atrium by the thoracic aorta in patients undergoing pulmonary vein isolation procedure for atrial fibrillation. J Interv Card Electrophysiol. 2007;19:29-36.

    Article  PubMed  Google Scholar 

  41. Sacher F, Jais P, Stephenson K, et al. Phrenic nerve injury after catheter ablation of atrial fibrillation. Indian Pacing Electrophysiol J. 2007;1:1-6.

    Google Scholar 

  42. Stojanovska J, Cronin P. Computed tomography imaging of the left atrium and pulmonary veins for radiofrequency ablation of atrial fibrillation. Semin Roentgenol. 2008;43:154-166.

    Article  PubMed  Google Scholar 

  43. Peters DC, Wylie JV, Hauser TH, et al. Recurrence of atrial fibrillation correlates with the extent of post-procedural late gadolinium enhancement: a pilot study. JACC Cardiovasc Imaging. 2009;2:317-318.

    Article  Google Scholar 

  44. Reddy VY, Schmidt EJ, Holmvang G, Fung M. Arrhythmia recurrence after atrial fibrillation ablation: Can magnetic resonance imaging identify gaps in atrial ablation lines? J Cardiovasc Electrophysiol. 2008;19:434-437.

    Article  PubMed  Google Scholar 

  45. Walsh EP. Arrhythmia in patients with congenital heart disease. Card Electrophysiol Rev. 2002;6:422-430.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada

    Sheldon M. Singh M.D.

  2. Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA

    Andre d’Avila M.D., Ph.D.

Authors
  1. Sheldon M. Singh M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andre d’Avila M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andre d’Avila M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Fondazione Cardiocentro Ticino, Via Tesserete 48 44, Lugano, CH-6900, Switzerland

    Angelo Auricchio

  2. Electrophysiology Lab., Department of Medicine, Massachusetts General Hospital, Fruit Street 55, Boston, 02114-2696, Massachusetts, USA

    Jagmeet Singh

  3. Hospital Gasthuisberg, Dept. Cardiology, Katholieke Universiteit Leuven, Herestraat 49, Leuven, 3000, Belgium

    Frank E. Rademakers

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London Limited

About this chapter

Cite this chapter

Singh, S.M., d’Avila, A. (2012). Anatomy Assessment for Atrial Arrhythmias. In: Auricchio, A., Singh, J., Rademakers, F. (eds) Cardiac Imaging in Electrophysiology. Springer, London. https://doi.org/10.1007/978-1-84882-486-7_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-486-7_6

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-485-0

  • Online ISBN: 978-1-84882-486-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation