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Pulmonary Vein Mapping
Stephan Achenbach, MD, FESC, FACC, FSCCT
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Pulmonary veins drain oxygenated blood from lungs into left atrium
            • Electrical foci inside pulmonary veins may trigger atrial fibrillation, a common arrhythmia
            • Catheter-based pulmonary vein isolation is widespread treatment for atrial fibrillation
          • Pulmonary vein anatomy is important to guide ablation procedures
          • Normal pulmonary vein anatomy: 2 left and 2 right pulmonary veins drain into left atrium
          • Variants of pulmonary vein anatomy are common and include supernumerary veins draining into left atrium or single ostia for left or right pulmonary veins
          • Anomalies of pulmonary veins are defined as any pattern where pulmonary veins drain into structures other than left atrium [most frequently inferior vena cava (IVC), right atrium, or superior vena cava]
            • Scimitar syndrome is infrequent pulmonary vein anomaly where pulmonary veins from right middle and lower lobe drain into IVC or right atrium

        IMAGING

        • General Features

          • Echocardiographic Findings

            • Angiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    CLINICAL ISSUES

                    • Presentation

                      DIAGNOSTIC CHECKLIST

                      • Image Interpretation Pearls

                        Selected References

                        1. Mulder BA et al: Pulmonary vein anatomy addressed by computed tomography and relation to success of second-generation cyroballoon ablation in paroxysmal atrial fibrillation. Clin Cardiol. ePub, 2019
                        2. Fender EA et al: Assessment and management of pulmonary vein occlusion after atrial fibrillation ablation. JACC Cardiovasc Interv. 11(16):1633-9, 2018
                        3. Merchant FM et al: Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies. J Interv Card Electrophysiol. 46(2):89-96, 2016
                        4. Tsyganov A et al: Anatomical predictors for successful pulmonary vein isolation using balloon-based technologies in atrial fibrillation. J Interv Card Electrophysiol. 44(3):265-71, 2015
                        5. den Uijl DW et al: Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol. 107(2):243-9, 2011
                        6. Rajiah P et al: Computed tomography of pulmonary venous variants and anomalies. J Cardiovasc Comput Tomogr. 4(3):155-63, 2010
                        7. Kaseno K et al: Prevalence and characterization of pulmonary vein variants in patients with atrial fibrillation determined using 3-dimensional computed tomography. Am J Cardiol. 101(11):1638-42, 2008. Erratum in: Am J Cardiol. 102(4):508, 2008
                        8. Lacomis JM et al: CT of the pulmonary veins. J Thorac Imaging. 22(1):63-76, 2007
                        9. Marom EM et al: Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 230(3):824-9, 2004
                        10. Lacomis JM et al: Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation. Radiographics. 23 Spec No:S35-48; discussion S48-50, 2003
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            • Clinical Issues

                              TERMINOLOGY

                              • Definitions

                                • Pulmonary veins drain oxygenated blood from lungs into left atrium
                                  • Electrical foci inside pulmonary veins may trigger atrial fibrillation, a common arrhythmia
                                  • Catheter-based pulmonary vein isolation is widespread treatment for atrial fibrillation
                                • Pulmonary vein anatomy is important to guide ablation procedures
                                • Normal pulmonary vein anatomy: 2 left and 2 right pulmonary veins drain into left atrium
                                • Variants of pulmonary vein anatomy are common and include supernumerary veins draining into left atrium or single ostia for left or right pulmonary veins
                                • Anomalies of pulmonary veins are defined as any pattern where pulmonary veins drain into structures other than left atrium [most frequently inferior vena cava (IVC), right atrium, or superior vena cava]
                                  • Scimitar syndrome is infrequent pulmonary vein anomaly where pulmonary veins from right middle and lower lobe drain into IVC or right atrium

                              IMAGING

                              • General Features

                                • Echocardiographic Findings

                                  • Angiographic Findings

                                    • CT Findings

                                      • MR Findings

                                        • Imaging Recommendations

                                          CLINICAL ISSUES

                                          • Presentation

                                            DIAGNOSTIC CHECKLIST

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Mulder BA et al: Pulmonary vein anatomy addressed by computed tomography and relation to success of second-generation cyroballoon ablation in paroxysmal atrial fibrillation. Clin Cardiol. ePub, 2019
                                              2. Fender EA et al: Assessment and management of pulmonary vein occlusion after atrial fibrillation ablation. JACC Cardiovasc Interv. 11(16):1633-9, 2018
                                              3. Merchant FM et al: Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies. J Interv Card Electrophysiol. 46(2):89-96, 2016
                                              4. Tsyganov A et al: Anatomical predictors for successful pulmonary vein isolation using balloon-based technologies in atrial fibrillation. J Interv Card Electrophysiol. 44(3):265-71, 2015
                                              5. den Uijl DW et al: Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol. 107(2):243-9, 2011
                                              6. Rajiah P et al: Computed tomography of pulmonary venous variants and anomalies. J Cardiovasc Comput Tomogr. 4(3):155-63, 2010
                                              7. Kaseno K et al: Prevalence and characterization of pulmonary vein variants in patients with atrial fibrillation determined using 3-dimensional computed tomography. Am J Cardiol. 101(11):1638-42, 2008. Erratum in: Am J Cardiol. 102(4):508, 2008
                                              8. Lacomis JM et al: CT of the pulmonary veins. J Thorac Imaging. 22(1):63-76, 2007
                                              9. Marom EM et al: Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 230(3):824-9, 2004
                                              10. Lacomis JM et al: Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation. Radiographics. 23 Spec No:S35-48; discussion S48-50, 2003