Arrhythmias & electrophysiology
Impact of right pulmonary vein anatomical variations on the phrenic nerve trajectory and pulmonary vein isolation strategy: Preprocedural imaging and 3D mapping insights
Authors' conclusion
RMPV or early branching of the RSPV increases the likelihood of PN capture in the RIPV proximal antrum by 10-fold and requires a more distal antral ablation line to avoid phrenic nerve injury.
Study context
- Population
- Patients who underwent preablation computed tomography or magnetic resonance imaging before pulmonary vein isolation
- Participants
- 103 consecutive patients
- Comparison
- Right middle PV (RMPV) or early branching of the right superior PV (RSPV) compared to typical anatomy
- Outcome
- Prevalence of right pulmonary vein (RPV) anatomical variations
Main finding
As reported in the abstract
Early branching of the RSPV
24%
RMPV present
21%
Anatomical variations more frequent in women
65% vs 38%
P=.01
Further findings
| Outcome | Typical anatomy | RMPV | Early branching of the RSPV | PR (95% CI) | |
|---|---|---|---|---|---|
| PN capture extending to the RIPV antrumRMPVvs typical anatomy | 3.6% | 59.1% | 64% | 10.3 (2.5–43.2) | |
| PN capture extending to the RIPV antrumEarly branching of the RSPVvs typical anatomy | 10.9 (2.7–44) | ||||
| Antral ablation line adjustments to avoid PN injuryRMPVvs typical anatomy | 7.1% | 50% | 56% | 5.6 (2–15.7) | |
| Antral ablation line adjustments to avoid PN injuryEarly branching of the RSPVvs typical anatomy | 5.2 (1.3–15.3) | ||||
| 0.050.21520Prevalence ratio (log scale) |
- Antral ablation line adjustments to avoid phrenic nerve (PN) injury — Required in all patients
- 28%
Original publication
Impact of right pulmonary vein anatomical variations on the phrenic nerve trajectory and pulmonary vein isolation strategy: Preprocedural imaging and 3D mapping insights. Heart Rhythm. Published 21 February 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →