Left Atrial Roof Vein

A 64 year old man diagnosed with persistent atrial fibrillation underwent a first ablation process.

Left atrial roof vein.

Pre operative three dimensional computed tomography revealed a unique left atrial la roof vein. Addition of linear ablation lesions principally in the atrial roof between the left and right superior pulmonary veins and mitral isthmus between the left inferior pulmonary vein and the mitral annulus led to improved success rates especially in patients with paroxysmal af and coexistent la enlargement 3 and in patients with persistent af 4. J am coll cardiol. Therefore it may have a myocardial sleeve as same as general pvs.

Isolation of the pulmonary veins pvs for the treatment of atrial fibrillation af is often supplemented with linear lesions within the left atrium la. During cardiac development the oblique vein of the left atrium vein of marshall passes from a superior aspect onto the epicardial surface of the left atrium in between the left atrial appendage and the left superior pulmonary vein to descend along the posterolateral atrial wall to join the coronary sinus figure 2 b. Electrophysiological findings showed expansion of the myocardial sleeve and local firing in the la. The ablation strategy consisted of liner ablations including the roof bottom and mitral isthmus as well as pulmonary vein isolation.

Clinical centers employ different ablation strategies which use imaging data together with electroanatomic mapping data depending on data availability. Catheter ablation therapy for persistent atrial fibrillation af typically includes pulmonary vein isolation pvi and may include additional ablation lesions that target patient specific anatomical electrical or structural features. In this case however the la roof vein had electrical activity and recorded local spontaneous firing suggesting that it can be the trigger of af. Ethanol infusion of 5 ml into the marshall vein was performed prior to pulmonary vein isolation while locating the advisortm hd grid mapping catheter abbott.

Roles of the left atrial roof and pulmonary veins in the anatomic substrate for persistent atrial fibrillation and ablation in a canine model. This vein ran from the right superior lobe of the lung to the left side of la roof.