Venous anatomy of the left ventricular summit: Therapeutic implications for ethanol infusion
Venous ethanol ablation (VEA) is effective for treatment of left ventricular (LV) summit (LVS) arrhythmias. The LVS venous anatomy is poorly understood and has inconsistent nomenclature. The purpose of this study was to delineate the LVS venous anatomy by selective venography and 3-dimensional (3D)...
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| Veröffentlicht in: | Heart rhythm 2021-09, Vol.18 (9), p.1557-1565 |
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| creator | Tavares, Liliana Fuentes, Stephanie Lador, Adi Da-wariboko, Akanibo Wang, Sufen Schurmann, Paul A. Dave, Amish S. Valderrábano, Miguel |
| description | Venous ethanol ablation (VEA) is effective for treatment of left ventricular (LV) summit (LVS) arrhythmias. The LVS venous anatomy is poorly understood and has inconsistent nomenclature.
The purpose of this study was to delineate the LVS venous anatomy by selective venography and 3-dimensional (3D) mapping during VEA and by venous-phase coronary computed tomographic angiography (vCTA).
We analyzed (1) LVS venograms and 3D maps of 53 patients undergoing VEA; and (2) 3D reconstructions of 52 vCTAs, tracing LVS veins.
Angiography identified the following LVS veins: (1) LV annular branch of the great cardiac vein (GCV) (19/53); (2) septal (rightward) branches of the anterior ventricular vein (AIV) (53/53); and (3) diagonal branches of the AIV (51/53). Collateral connections between LVS veins and outflow, conus, and retroaortic veins were common. VEA was delivered to target arrhythmias in 38 of 53 septal, 6 of 53 annular, and 2 of 53 diagonal veins. vCTA identified LVS veins (range 1–5) in a similar distribution. GCV–AIV transition could either form an angle close to the left main artery bifurcation (n = 16; 88° ± 13°) or cut diagonally (n = 36; 133°±12°) (P ≤.001). Twenty-one patients had LV annular vein. In 28 patients only septal LVS veins were visualized in vCTA, in 2 patients only diagonal veins and in 22 patients both septal and diagonal veins were seen. In 39 patients the LVS veins reached the outflow tracts and their vicinity.
We provide a systematic atlas and nomenclature of LVS veins related to arrhythmogenic substrates. vCTA can be useful for noninvasive evaluation of LVS veins before ethanol ablation. |
| doi_str_mv | 10.1016/j.hrthm.2021.05.008 |
| format | Article |
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The purpose of this study was to delineate the LVS venous anatomy by selective venography and 3-dimensional (3D) mapping during VEA and by venous-phase coronary computed tomographic angiography (vCTA).
We analyzed (1) LVS venograms and 3D maps of 53 patients undergoing VEA; and (2) 3D reconstructions of 52 vCTAs, tracing LVS veins.
Angiography identified the following LVS veins: (1) LV annular branch of the great cardiac vein (GCV) (19/53); (2) septal (rightward) branches of the anterior ventricular vein (AIV) (53/53); and (3) diagonal branches of the AIV (51/53). Collateral connections between LVS veins and outflow, conus, and retroaortic veins were common. VEA was delivered to target arrhythmias in 38 of 53 septal, 6 of 53 annular, and 2 of 53 diagonal veins. vCTA identified LVS veins (range 1–5) in a similar distribution. GCV–AIV transition could either form an angle close to the left main artery bifurcation (n = 16; 88° ± 13°) or cut diagonally (n = 36; 133°±12°) (P ≤.001). Twenty-one patients had LV annular vein. In 28 patients only septal LVS veins were visualized in vCTA, in 2 patients only diagonal veins and in 22 patients both septal and diagonal veins were seen. In 39 patients the LVS veins reached the outflow tracts and their vicinity.
We provide a systematic atlas and nomenclature of LVS veins related to arrhythmogenic substrates. vCTA can be useful for noninvasive evaluation of LVS veins before ethanol ablation.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2021.05.008</identifier><identifier>PMID: 33989783</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Ablation ; Ablation Techniques - methods ; Computed tomography ; Coronary Angiography - methods ; Coronary venous system ; Coronary Vessel Anomalies - complications ; Coronary Vessel Anomalies - diagnosis ; Coronary Vessel Anomalies - therapy ; Coronary Vessels - diagnostic imaging ; Electrocardiography - methods ; Ethanol ; Ethanol - administration & dosage ; Female ; Humans ; Infusions, Intravenous ; Left ventricular summit ; Male ; Middle Aged ; Phlebography - methods ; Tachycardia, Ventricular - physiopathology ; Tachycardia, Ventricular - therapy ; Ventricular arrhythmia</subject><ispartof>Heart rhythm, 2021-09, Vol.18 (9), p.1557-1565</ispartof><rights>2021 Heart Rhythm Society</rights><rights>Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-38e16280cdda6e51e81c6714715cd9e1658d854f2b066234d3daddd2cba07e743</citedby><cites>FETCH-LOGICAL-c525t-38e16280cdda6e51e81c6714715cd9e1658d854f2b066234d3daddd2cba07e743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hrthm.2021.05.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33989783$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tavares, Liliana</creatorcontrib><creatorcontrib>Fuentes, Stephanie</creatorcontrib><creatorcontrib>Lador, Adi</creatorcontrib><creatorcontrib>Da-wariboko, Akanibo</creatorcontrib><creatorcontrib>Wang, Sufen</creatorcontrib><creatorcontrib>Schurmann, Paul A.</creatorcontrib><creatorcontrib>Dave, Amish S.</creatorcontrib><creatorcontrib>Valderrábano, Miguel</creatorcontrib><title>Venous anatomy of the left ventricular summit: Therapeutic implications for ethanol infusion</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Venous ethanol ablation (VEA) is effective for treatment of left ventricular (LV) summit (LVS) arrhythmias. The LVS venous anatomy is poorly understood and has inconsistent nomenclature.
The purpose of this study was to delineate the LVS venous anatomy by selective venography and 3-dimensional (3D) mapping during VEA and by venous-phase coronary computed tomographic angiography (vCTA).
We analyzed (1) LVS venograms and 3D maps of 53 patients undergoing VEA; and (2) 3D reconstructions of 52 vCTAs, tracing LVS veins.
Angiography identified the following LVS veins: (1) LV annular branch of the great cardiac vein (GCV) (19/53); (2) septal (rightward) branches of the anterior ventricular vein (AIV) (53/53); and (3) diagonal branches of the AIV (51/53). Collateral connections between LVS veins and outflow, conus, and retroaortic veins were common. VEA was delivered to target arrhythmias in 38 of 53 septal, 6 of 53 annular, and 2 of 53 diagonal veins. vCTA identified LVS veins (range 1–5) in a similar distribution. GCV–AIV transition could either form an angle close to the left main artery bifurcation (n = 16; 88° ± 13°) or cut diagonally (n = 36; 133°±12°) (P ≤.001). Twenty-one patients had LV annular vein. In 28 patients only septal LVS veins were visualized in vCTA, in 2 patients only diagonal veins and in 22 patients both septal and diagonal veins were seen. In 39 patients the LVS veins reached the outflow tracts and their vicinity.
We provide a systematic atlas and nomenclature of LVS veins related to arrhythmogenic substrates. vCTA can be useful for noninvasive evaluation of LVS veins before ethanol ablation.</description><subject>Ablation</subject><subject>Ablation Techniques - methods</subject><subject>Computed tomography</subject><subject>Coronary Angiography - methods</subject><subject>Coronary venous system</subject><subject>Coronary Vessel Anomalies - complications</subject><subject>Coronary Vessel Anomalies - diagnosis</subject><subject>Coronary Vessel Anomalies - therapy</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Electrocardiography - methods</subject><subject>Ethanol</subject><subject>Ethanol - administration & dosage</subject><subject>Female</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Left ventricular summit</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Phlebography - methods</subject><subject>Tachycardia, Ventricular - physiopathology</subject><subject>Tachycardia, Ventricular - therapy</subject><subject>Ventricular arrhythmia</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV1rFDEUhoMo9kN_gSC59Gan-ZhkMoKCFG0LBW_aXgkhm5xxsswka5JZ6L9v1q3F3vQqh5z3vOflPAh9oKShhMqzTTOmMs4NI4w2RDSEqFfomAohV1x19PW-bruVYB09Qic5bwhhvST8LTrivFd9p_gx-nUHIS4Zm2BKnO9xHHAZAU8wFLyDUJK3y2QSzss8-_IZ34yQzBaW4i3283by1hQfQ8ZDTBjKaEKcsA_DkuvvO_RmMFOG94_vKbr98f3m_HJ1_fPi6vzb9coKJkpNC1QyRaxzRoKgoKiVHW07Kqzra08op0Q7sDWRkvHWcWecc8yuDemga_kp-nrw3S7rGZzd5zaT3iY_m3Svo_H6eSf4Uf-OO61a2hPFqsGnR4MU_yyQi559tjBNJkC9jmaCKaoYE7JK-UFqU8w5wfC0hhK956I3-i8XveeiidCVS536-H_Cp5l_IKrgy0EA9U47D0ln6yFYcD6BLdpF_-KCB7BRouU</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Tavares, Liliana</creator><creator>Fuentes, Stephanie</creator><creator>Lador, Adi</creator><creator>Da-wariboko, Akanibo</creator><creator>Wang, Sufen</creator><creator>Schurmann, Paul A.</creator><creator>Dave, Amish S.</creator><creator>Valderrábano, Miguel</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210901</creationdate><title>Venous anatomy of the left ventricular summit: Therapeutic implications for ethanol infusion</title><author>Tavares, Liliana ; Fuentes, Stephanie ; Lador, Adi ; Da-wariboko, Akanibo ; Wang, Sufen ; Schurmann, Paul A. ; Dave, Amish S. ; Valderrábano, Miguel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-38e16280cdda6e51e81c6714715cd9e1658d854f2b066234d3daddd2cba07e743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Ablation</topic><topic>Ablation Techniques - methods</topic><topic>Computed tomography</topic><topic>Coronary Angiography - methods</topic><topic>Coronary venous system</topic><topic>Coronary Vessel Anomalies - complications</topic><topic>Coronary Vessel Anomalies - diagnosis</topic><topic>Coronary Vessel Anomalies - therapy</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Electrocardiography - methods</topic><topic>Ethanol</topic><topic>Ethanol - administration & dosage</topic><topic>Female</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Left ventricular summit</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Phlebography - methods</topic><topic>Tachycardia, Ventricular - physiopathology</topic><topic>Tachycardia, Ventricular - therapy</topic><topic>Ventricular arrhythmia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tavares, Liliana</creatorcontrib><creatorcontrib>Fuentes, Stephanie</creatorcontrib><creatorcontrib>Lador, Adi</creatorcontrib><creatorcontrib>Da-wariboko, Akanibo</creatorcontrib><creatorcontrib>Wang, Sufen</creatorcontrib><creatorcontrib>Schurmann, Paul A.</creatorcontrib><creatorcontrib>Dave, Amish S.</creatorcontrib><creatorcontrib>Valderrábano, Miguel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tavares, Liliana</au><au>Fuentes, Stephanie</au><au>Lador, Adi</au><au>Da-wariboko, Akanibo</au><au>Wang, Sufen</au><au>Schurmann, Paul A.</au><au>Dave, Amish S.</au><au>Valderrábano, Miguel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Venous anatomy of the left ventricular summit: Therapeutic implications for ethanol infusion</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>18</volume><issue>9</issue><spage>1557</spage><epage>1565</epage><pages>1557-1565</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Venous ethanol ablation (VEA) is effective for treatment of left ventricular (LV) summit (LVS) arrhythmias. The LVS venous anatomy is poorly understood and has inconsistent nomenclature.
The purpose of this study was to delineate the LVS venous anatomy by selective venography and 3-dimensional (3D) mapping during VEA and by venous-phase coronary computed tomographic angiography (vCTA).
We analyzed (1) LVS venograms and 3D maps of 53 patients undergoing VEA; and (2) 3D reconstructions of 52 vCTAs, tracing LVS veins.
Angiography identified the following LVS veins: (1) LV annular branch of the great cardiac vein (GCV) (19/53); (2) septal (rightward) branches of the anterior ventricular vein (AIV) (53/53); and (3) diagonal branches of the AIV (51/53). Collateral connections between LVS veins and outflow, conus, and retroaortic veins were common. VEA was delivered to target arrhythmias in 38 of 53 septal, 6 of 53 annular, and 2 of 53 diagonal veins. vCTA identified LVS veins (range 1–5) in a similar distribution. GCV–AIV transition could either form an angle close to the left main artery bifurcation (n = 16; 88° ± 13°) or cut diagonally (n = 36; 133°±12°) (P ≤.001). Twenty-one patients had LV annular vein. In 28 patients only septal LVS veins were visualized in vCTA, in 2 patients only diagonal veins and in 22 patients both septal and diagonal veins were seen. In 39 patients the LVS veins reached the outflow tracts and their vicinity.
We provide a systematic atlas and nomenclature of LVS veins related to arrhythmogenic substrates. vCTA can be useful for noninvasive evaluation of LVS veins before ethanol ablation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33989783</pmid><doi>10.1016/j.hrthm.2021.05.008</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Heart rhythm, 2021-09, Vol.18 (9), p.1557-1565 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Ablation Ablation Techniques - methods Computed tomography Coronary Angiography - methods Coronary venous system Coronary Vessel Anomalies - complications Coronary Vessel Anomalies - diagnosis Coronary Vessel Anomalies - therapy Coronary Vessels - diagnostic imaging Electrocardiography - methods Ethanol Ethanol - administration & dosage Female Humans Infusions, Intravenous Left ventricular summit Male Middle Aged Phlebography - methods Tachycardia, Ventricular - physiopathology Tachycardia, Ventricular - therapy Ventricular arrhythmia |
| title | Venous anatomy of the left ventricular summit: Therapeutic implications for ethanol infusion |
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