ArticleSurgical and radiologic anatomy : SRA2020
Histological evaluation of atrial muscle sleeve of pulmonary veins as relevant to trigger mapping and ablation.
Article in Surgical and radiologic anatomy : SRA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed, 8 citations in OpenAlex.
- Distribution of peak frequency and omnipolar voltage in electrograms across the atrial body and thoracic veins in a normal heart.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024Article
- Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation.Frontiers in cardiovascular medicine · 2022Article
- Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: an immunohistochemical proof.Surgical and radiologic anatomy : SRA · 2022Article
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Authors and funding
3 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThe atrial myocardial sleeve of the pulmonary vein is the most common source of arrhythmogenic triggers in atrial fibrillation. The present study was designed to study the atrial muscle sleeve in detail, to help in planning and execution of "trigger mapping and ablation" procedure, used for treating resistant atrial fibrillation.
methodsA longitudinal tissue section was taken along the length of each pulmonary vein including the posterior wall of the left atrium, from 15 normal human formalin fixed hearts. The histological and micro-morphometric details of the atrial muscle sleeve were studied.
resultsA muscle sleeve composed of cardiac muscle was found in each pulmonary vein, situated between adventitia and media, and separated from media by clearly defined connective tissue. The fiber arrangement was non uniform and angular changes in the fiber direction were frequent. Autonomic ganglia were found in the adventitia. The sleeve was tapering distally but reduction was not circumferentially uniform, minimum thickness was more for right (~ 0.2 mm) than for left veins (0.1 mm). The mean atrial sleeve length was 6.3 mm; the left veins had longer sleeve then right while left inferior veins had the maximum mean length.
conclusionThe trigger mapping should be done for 2 cm on pulmonary veins to fully cover the atrial muscle sleeve. The gradual tapering of the atrial sleeve indicates that the maximum intensity ablative lesions would be needed at the veno-atrial junction while the ablation power should be reduced distally. Distal triggers on right veins would need more ablation then on the left veins.
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