Korean Circ J.  2010 Sep;40(9):442-447. 10.4070/kcj.2010.40.9.442.

A Transthoracic Echocardiographic Follow-Up Study After Catheter Ablation of Atrial Fibrillation: Can We Detect Pulmonary Vein Stenosis by Transthoracic Echocardiography?

• Lee DH
• Oh YS
• Shin WS
• Kim JH
• Choi YS
• Jang SW
• Park CS
• Youn HJ
• Lee MY
• Chung WS
• Seung KB
• Rho TH
• Kim JH
• Choi KB

• KMID: 1456136
• DOI: http://doi.org/10.4070/kcj.2010.40.9.442

Abstract

BACKGROUND AND OBJECTIVES
While pulmonary vein isolation (PVI) is an effective curative procedure for patients with atrial fibrillation (AF), pulmonary vein (PV) stenosis is a potential complication which may lead to symptoms that are often unrecognized. The aim of this study was to compare differences between ablation sites in pulmonary venous flow (PVF) measured by transthoracic Doppler echocardiography (TTE) before and after PVI.
SUBJECTS AND METHODS
One hundred five patients (M : F=64 : 41; mean age 56+/-10 years) with paroxysmal AF (n=78) or chronic, persistent AF (n=27) were enrolled. PVI strategies consisted of ostial ablation (n=75; OA group) and antral ablation using an electroanatomic mapping system (n=30; AA group). The ostial diameter was estimated by magnetic resonance imaging (MRI) in patients with PVF > or =110 cm/sec by TTE after PVI.
RESULTS
No patient complained of PV stenosis-related symptoms. Changes in mean peak right PV systolic (-6.7+/-28.1 vs. 10.9+/-25.9 cm/sec, p=0.038) and diastolic (-4.1+/-17.0 vs. 9.9+/-25.9 cm/sec, p=0.021) flow velocities were lower in the AA group than in the OA group. Although the change in mean peak systolic flow velocity of the left PV before and after PVI in the AA group was significantly lower than the change in the OA group (-13.4+/-25.1 vs. 9.2+/-22.3 cm/sec, p=0.016), there was no difference in peak diastolic flow velocity. Two patients in the OA group had high PVF velocities (118 cm/sec and 133 cm/sec) on TTE, and their maximum PV stenoses measured by MRI were 62.5% and 50.0%, respectively.
CONCLUSION
PV stenosis after PVI could be detected by TTE, and PVI by antral ablation using an electroanatomic mapping system might be safer and more useful for the prevention of PV stenosis.

Keyword

Atrial fibrillation; Catheter ablation; Pulmonary veins; Echocardiography

MeSH Terms

Atrial Fibrillation
Carbamates
Catheter Ablation
Catheters
Constriction, Pathologic
Echocardiography
Echocardiography, Doppler
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Organometallic Compounds
Pulmonary Veins
Carbamates
Organometallic Compounds

Figure

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  Fig. 1 Fluoroscopic image demonstrating segmental ostial ablation of PV using Lasso guidance. LAO: left anterior oblique view, PV: pulmonary vein; HRA: high right atrium, CS: coronary sinus, ABL: ablation catheter.

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  Fig. 2 CARTOMERGE images of LA and PV that have registered a 3-D CT image with the GPS-like CARTO system (endoscopic view). LA: left atrium, PV: pulmonary vein, 3-D CT: 3-dimensional computed tomography, GPS: global positioning system.

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  Fig. 3 Doppler (A) and MR imaging (B: pre ablation, C: post ablation) of PV in patients with pulmonary vein stenosis that developed after PVI. The white arrow showed significant right superim vein stenosis. MR: magnetic resonance, PV: pulmonary vein, PVI: pulmonary vein isolation.

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  Fig. 4 Changes in peak flow velocity according to ablation sites and use of an electroanatomic (CARTOMERGE) mapping system. This figure shows changes in peak systolic and diastolic flow velocities of RPV (A and B) and LPV (C and D) before and after PVI. RPV: right pulmonary vein, LPV: left pulmonary vein, PVI: pulmonary vein isolation, OA: ostial ablation, AA: antral ablation.

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