Pre-Procedural Imaging to Direct Catheter Ablation of Atrial Fibrillation: Anatomy and Ablation Strategy.

Successful catheter ablation of atrial
fibrillation (AF) requires a detailed understanding of left atrial anatomy in
order to maximize the safety and efficacy of the procedure. Common and rare variants of left atrial and
pulmonary venous anatomy have been described which can affect the optimal
ablation strategy for each individual patient. These variants include the presence of a right or left middle pulmonary
vein, a left or right common pulmonary vein, a common inferior pulmonary vein,
a right top pulmonary vein, and other rare forms of anomalous pulmonary venous
drainage. There are also important
patient-specific differences in pulmonary venous ridges and left atrial roof
morphology. Pre-procedural CT or MR
imaging can define these anatomic variants in exquisite detail and be used with
image-integration strategies to direct the ablation procedure. In this review, we describe common and
uncommon variants that can be identified by pre-procedural imaging, and suggest
ablation strategies tailored to these anatomic variants.