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Abstract
<jats:p>Catheter pulmonary vein isolation (PVI) is currently considered a key rhythm-control strategy in patients with symptomatic, drug-refractory atrial fibrillation, and the number of ablation procedures continues to increase steadily each year. The success and safety of PVI largely depend on individual anatomical characteristics of the pulmonary veins and the left atrium.The aim – to evaluate the prevalence and patterns of pulmonary vein anatomical variants assessed by computed tomography in patients with atrial fibrillation scheduled for catheter pulmonary vein isolation.Methods. This retrospective single-center study included 164 patients with atrial fibrillation who underwent preprocedural CT angiography of the pulmonary veins between 2020 and 2025. The number, drainage pattern, ostial configuration, and anatomical variants of pulmonary veins were analyzed using three-dimensional reconstruction.Results. Typical anatomy with four separate pulmonary veins was identified in 64.6 % of patients. Anatomical variants were detected in 35.4 % of cases. The most frequent variants were left-sided common trunk (15.2 %) and additional right pulmonary veins (13.4 %). Left-sided pseudo-trunk was observed in 3.0 % of patients. CT coronary assessment additionally revealed a substantial prevalence of concomitant coronary artery disease or limited diagnostic image quality.Conclusions. Anatomical variability of the pulmonary veins is common among patients with atrial fibrillation and has important implications for procedural planning of pulmonary vein isolation. Preprocedural CT with 3D reconstruction enables detailed anatomical assessment, supports individualized ablation strategies, and may contribute to improved procedural safety and effectiveness.</jats:p>