PURPOSE: Variations in the anatomy of pulmonary veins can influence selection of approaches of atrial fibrillation catheter ablation. Therefore, preprocedural evaluation and knowledge of pulmonary veins anatomy is crucial for proper mapping and the successful ablation of atrial fibrillation. The aim of this observational study was to assess CT angiography scans and perform detailed analysis of pulmonary veins morphology in patients scheduled for catheter ablation of atrial fibrillation. METHODS: CT angiography was performed in 771 individuals (223 females, 548 males, mean age 58.4 ± 10.7 years). Pulmonary veins anatomy was evaluated using 3D models. The patterns used for evaluation included typical anatomy with four separate pulmonary veins, a common left ostium, and various types of accessory veins either alone or in combination with common left ostia. RESULTS: An anatomical variant with common left ostium was observed as the most prevalent anatomy (44%). The typical variant was observed in 34.8% of patients. Accessory pulmonary veins were observed predominantly on the right side. The prevalence of anatomical variants did not differ between sexes with the exception of the unclassifiable category U (4.4% vs. 9%, p < 0.05). CONCLUSIONS: Our study shows that a considerable number of atypical anatomies is present in patients undergoing AF catheter ablation. This knowledge may influence the choice of instrumentation. The data could be possibly helpful also in development of new ablation techniques.

• Keywords
• Atrial fibrillation, CT angiography, Pulmonary veins anatomy, Pulmonary veins morphology,
• MeSH
• Computed Tomography Angiography MeSH
• Atrial Fibrillation * surgery   diagnostic imaging   physiopathology   MeSH
• Phlebography MeSH
• Catheter Ablation * MeSH
• Middle Aged MeSH
• Humans MeSH
• Predictive Value of Tests MeSH
• Aged MeSH
• Pulmonary Veins * surgery   diagnostic imaging   MeSH
• Treatment Outcome MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

• Keywords
• Ablation, Anticoagulation, Arrhythmia, Atrial fibrillation, Atrial flutter, Atrial tachycardia, Catheter ablation, Stroke, Surgical ablation,
• MeSH
• Atrial Fibrillation diagnosis   physiopathology   surgery   MeSH
• Catheter Ablation adverse effects   standards   MeSH
• Consensus MeSH
• Cryosurgery adverse effects   standards   MeSH
• Humans MeSH
• Risk Factors MeSH
• Cardiac Catheterization adverse effects   standards   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Practice Guideline MeSH

• Keywords
• Ablation, Anticoagulation, Arrhythmia, Atrial fibrillation, Atrial flutter, Atrial tachycardia, Catheter ablation, Stroke, Surgical ablation,
• MeSH
• Ablation Techniques standards   MeSH
• Atrial Fibrillation surgery   MeSH
• Cardiology * MeSH
• Catheter Ablation standards   MeSH
• Consensus Development Conferences as Topic * MeSH
• Humans MeSH
• Heart Conduction System surgery   MeSH
• Societies, Medical * MeSH
• Check Tag
• Humans MeSH
• Publication type
• News MeSH

INTRODUCTION: 3D echocardiography allows imaging and analysis of cardiovascular structures as they move in time and space, thus creating possibility for creation of 4D datasets (3D + time). Intracardiac echocardiography (ICE) further broadens the spectrum of echocardiographic techniques by allowing detailed imaging of intracardiac anatomy with 3D reconstructions. The paper reviews the current status of development of 3D and 4D echocardiography in electrophysiology. In ablation area, 3D echocardiography can enhance the performance of catheter ablation for complex arrhythmias such as atrial fibrillation. Currently, several strategies to obtain 3D reconstructions from ICE are available. One involves combination with electroanatomical mapping system; others create reconstruction from standard phased-array or single-element ICE catheter using special rotational or pull-back devices. Secondly, 3D echocardiography may be used for precise assessment of cardiac dyssynchrony before cardiac resynchronization therapy. Its reliable detection is expected to minimize number of non-responders to this treatment and optimize left ventricular lead positioning to get maximum hemodynamic benefit. CONCLUSION: The main potential benefit of 3D and 4D echocardiography in electrophysiology lie in real-time guidance of complex ablation procedures and precise assessment of cardiac dyssynchrony.

• MeSH
• Echocardiography, Four-Dimensional methods   MeSH
• Echocardiography, Three-Dimensional methods   MeSH
• Electric Countershock methods   MeSH
• Electrophysiologic Techniques, Cardiac MeSH
• Catheter Ablation MeSH
• Humans MeSH
• Arrhythmias, Cardiac diagnostic imaging   therapy   MeSH
• Cardiac Catheterization MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Intracardiac echocardiography (ICE) broadens the spectrum of echocardiographic techniques. Modern 10F sector echocardiographic catheters introduced into the right atrium allow high quality imaging of all cardiac structures, including pulse and continuous wave Doppler and/or color Doppler. The main indication for ICE appears to be monitoring of catheter ablation of complex arrhythmic substrates such atrial fibrillation, postincisional tachycardias and ventricular tachycardias. The other important role of ICE is the early diagnosis and prevention of complications during ablation procedures. These include those occurring during transseptal catheterization, damage to cardiac structures, left atrial thrombus formation, pulmonary venous stenosis, esophageal injury and pericardial effusion.

• MeSH
• Surgery, Computer-Assisted methods   MeSH
• Echocardiography methods   MeSH
• Ultrasonography, Interventional methods   MeSH
• Humans MeSH
• Body Surface Potential Mapping methods   MeSH
• Heart Conduction System diagnostic imaging   surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH