| Objective: Atrial fibrillation(AF)is the most common tachyarrhythmia,as it can lead to thrombosis and heart failure has become a high morbidity and mortality disease for human health to bring great harm.Some scholars have found that the impulse of the ectopic pacemaker of the pulmonary vein is an important factor in the onset of atrial fibrillation.In recent years,radiofrequency ablation of the pulmonary vein and cryoballoon catheter ablation has become effective methods for the treatment of atrial fibrillation,and in the latest guidelines for the treatment of paroxysmal atrial fibrillation has been recommended as a class I.Regardless of the surgical approach,we need to understand the size,shape and variation of the pulmonary vein to determine the surgical approach and contribute to the success operation of radiofrequency ablation.It also makes people start to pay attention to structural studies of pulmonary vein anatomy.Previous studies have reported the size of the pulmonary vein,shape,arranged and the main types of variation,while the study showed that the individual differences in pulmonary vein,the variation rate was high.Was the anatomy and variation of the pulmonary vein related to the occurrence and development of atrial fibrillation? It was not clear.The purpose of this study was to observe the anatomical characteristics of the pulmonary vein and left atrium in patients with atrial fibrillation and the normal,and to analyze which anatomical characteristics and variation of the pulmonary vein may be related to atrial fibrillation.Method: The subjects were from December 2015 to December 2016 in the Second Hospital of Hebei Medical University,Department of Cardiology,hospitalized 188 cases of AF patients undergoing radiofrequency ablation,in which 128 cases of paroxysmal atrial fibrillation,60 cases of persistent atrial fibrillation.Another 46 patients who had sinus rhythm as control group.All subjects should be excluded from the following diseases: 1)Required surgical operations valvular atrial fibrillation.2)Pulmonary hypertension.3)Mediastinal and pulmonary lesions.4)Pericardium and pleural effusion.5)Congenital and rheumatic heart disease.6)History of myocardial infarction.7)In addition to atrial fibrillation,combined with heart failure caused by other diseases.Collected all patients` gender,age,medical history,physical examination,laboratory tests and ECG results,etc.All patients underwent multi-slice spiral CT angiography.Three-dimensional reconstruction of the pulmonary vein and left atrium was performed.The diameter left atrium and pulmonary veins were measured by postconditioning technique.Definition of the variations and measurement of pulmonary vein: 1)A common ostium was defined by the presence of a common opening of the pulmonary veins and ipsilateral pulmonary vein spacing less than 5mm.2)The supernumerary ostium was defined by the presence of one or more pulmonary veins except standard four pulmonary veins.3)The ostial branchs was the pulmonary vein branch which lack of pulmonary vein trunk and directly open in the left atrium,and from the left atrial-pulmonary vein junction less than 5mm.4)The ostial noncircularity(maximum diameter-minimum diameter)/ maximum diameter,the smaller ostial noncircularity,the pulmonary vein opening is closer to the circular shape.5)The incidence of pulmonary vein variation was statistically reported.Statistical analysis was performed using SPSS21.0 statical package.P <0.05 was considered statistically significant.Result: 1 Comparison of the standard four pulmonary vein in three groups: 1.1Patients with atrial fibrillation(including paroxysmal and persistent AF):the maximum diameter of pulmonary vein opening: LSPV was the largest,followed by RSPV,LIPV and RIPV were the smallest.The minimum diameter of pulmonary vein opening: RSPV and RIPV were the largest,followed by LSPV,LIPV was the smallest.The average diameter,circumference and area of the pulmonary vein opening: RSPV and LSPV were the largest,followed by RIPV,LIPV was the smallest.The ostial noncircularity:LSPV and LIPV were the largest,followed by RSPV,RIPV was the smallest.The distance from vein ostium to first branch in order: LSPV,LIPV,RSPV,RIPV.1.2 In control group,the maximum diameter of pulmonary vein opening: RSPV and LSPV were the largest,followed by RIPV,RSPV was the smallest.The minimum diameter,average diameter,circumference and area of the pulmonary vein opening: RSPV,RIPV and LSPV were larger than LIPV.The ostial noncircularity: LSPV and LIPV were the largest,followed by RSPV and RIPV was the smallest.The distance from vein ostium to first branch: LSPV and RIPV were the largest,followed by RSPV and RIPV was the smallest.2 Comparison of the pulmonary veins among three group: 2.1The maximum diameter,minimum diameter,mean diameter,ostial circumference and area of LSPV and LIPV among the three groups were statistically significant(P<0.05).The persistent group was larger than paroxysmal group and control,but there was not in RSPV and RIPV(P> 0.05).2.2 Comparison of the ostial noncircularity,the results of the three groups were not statistically different(P> 0.05).2.3 The distance from vein ostium to first branch:RSPV and LIPV: The control and paroxysmal group was greater than persistent group(P <0.05),no statistically significant difference among the three groups in RIPV and LSPV.2.4 Distance between ipsilateral pulmonary veins ostium:The persistent and paroxysmal group was larger than control(P <0.05).2.5 According to the duration of atrial fibrillation,patients with persistent AF were divided into three groups: Group A:> 7 days and <1 month,Group B: ≥ 1 month and <1 year,Group C: ≥ 1 year.There was no significant difference in pulmonary vein ostium diameter,distance between pulmonary veins ostium and the distance from vein ostium to first branch(P> 0.05).3 Comparison of the variation and its incidence of pulmonary veins among groups: 3.1 The incidence of common ostium: 32.6% in the control group,25.0% in the paroxysmal group,and 23.3% in the persistent group.There was no significant difference among the three groups(P> 0.05).3.2 The incidence of supernumerary ostium: 10.9% in the control group,15.6% in the paroxysmal group,and 25% in the persistent group.The incidence was greater in the AF patients than in the control subjects,but no significant difference was found among the three groups(P = 0.12).3.3 The incidence of ostial branch: 6.5% in the control group,23.4% in the paroxysmal group,and 28.3% in the persistent group.There was significant difference among the three groups(P <0.05).The incidence of ostial branches in patients with atrial fibrillation was higher than that in controls.4 There was significant difference among the three groups in the left atrial diameter(P <0.05): The vertical diameter of the persistent and paroxysmal group was larger than the control group,the transverse diameter and anteroposterior diameter and volume of persistent group was larger than the paroxysmal group was larger than the control group.There was no significant difference among group A,B and C(P> 0.05).5 There was significant difference among the three groups in appendage ridge(the width of the left upper pulmonary vein to the left atrial appendage)(P <0.05): Patients with atrial fibrillation was wider than controls.Conclusion: 1 In AF patients,the mean diameter,ostium circumference and area of RSPV and LSPV were the largest,LIPV was the smallest.Regardless of patients with AF or control,RIPV was roundest,followed by RSPV,the ostial noncircularity of LSPV and LIPV was largest.From far to near,the distance from vein ostium to first branch in order: LSPV,LIPV,RSPV,RIPV.2 The left pulmonary vein ostium in patients with persistent AF was larger than that in patients with paroxysmal AF and controls.There was no significant difference in right pulmonary veins.3 The distance between upper and lower pulmonary veins of AF patients was larger than controls.4 Compared with the controls,the incidence of common ostium in AF patients was not significantly increased,supernumerary ostium was higher but no statistical differences,ostial branch was significantly increased.5 Compared with the controls,the left atrium of AF patients was significantly enlarged,and the enlargement in persistent group was more obvious than paroxysmal group,especially the transverse and anteroposterior diameter.6 The appendage ridge of AF patients was wider than controls. |
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