Clinical Electrophysiology -> Ventricular Arrhythmias -> Mapping & Imaging D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-048 - Ct Venous Imaging Of Lv Summit Veins: Utility For Mapping (ID 680)

 L. Tavares: Nothing relevant to disclose.


Background: Ethanol infusion in septal branches of the anterior interventricular vein (AIV) can be effective in treating ventricular arrhythmias from the LV summit (LVS). However, success depends on the presence of suitable veins. A detailed understanding of AIV branching in the LVS is lacking.
Objective: To delineate LVS venous anatomy with venous coronary computed tomography (CT) angiography.
Methods: 22 patients, 68 % male, age 67± 10, underwent diastolic delayed phase (venous) coronary CT angiography, using 192-slice 3rd generation DSCT scanner (SOMATOM force, Siemens, Germany). The venous anatomy was segmented using commercially available software (syngo.via®, Siemens), manually tracing all visible myocardial tributaries of great cardiac vein (GCV), and AIV in the LVS region.
Results: We found substantial variability. The AIV-GCV transition could either form an angle close to the left main artery bifurcation (n=7, angle 83⁰±15⁰) or cut diagonally (n=15, angle 138⁰±14⁰), p≤0.001. In all cases, LVS veins were present (range 1 to 5), either arising from GCV or AIV. GCV LVS tributaries coursed along mitral annulus, whereas AIV LVS tributaries were either septal, diagonal or both. Septal veins were seen in 20 patients, range 1 to 4. Diagonal veins were seen in 8 patients, range 1 to 2. In 7 patients both diagonal and septal veins were seen, range 2 to 5. LVS veins reached the lateral aortic root wall and the posterior wall of the RVOT. See Figure.
Conclusion: LVS venous anatomy is complex and variable but can be successfully delineated by CT diastolic delayed phase as a useful tool for noninvasive evaluation prior to LV summit ablation procedures.