Cor Vasa 2006, 48(1):19-23 | DOI: 10.33678/cor.2006.010

The role of transesophageal echocardiography in assessing morphological and functional pulmo-nary vein parameters with an emphasis on detecting pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation.

Miloslav Dorda^*, Martin Fiala, Jaroslav Januška, Libor Škňouřil, Marian Branny

Kardiologické oddělení, Kardiocentrum, Nemocnice Podlesí a. s., Třinec, Česká republika

Aim:
The aim of our study was to define the potential uses of transesophageal echocardiography in the diagnosis of functional and morphologic parameters of pulmonary veins with special emphasis on detecting pulmonary vein stenosis fol-lowing radiofrequency catheter ablation for atrial fibrillation using electroanatomically navigated circumscribed lesions with pulmonary vein isolation.

Method:
Using Doppler imaging before and one month after ablation for atrial fibrillation, the average diameter of pulmonary vein ostia and peak blood flow rates (Vmax) were compared in 66 patients (16 women) with a mean age of 54.6 ± 8 (25-75) years. Mild, moderate and severe stenosis was defined as up to 49%, 50-69%, and 70% and over narrowing of the pulmonary vein lumen, respectively. Other criteria included a doubling in Vmax (by 100% and over) and detection of turbulent flow in pulmonary veins. The diagnosis of pulmonary vein was established in the presence of at least two of the three above criteria.

Results:
No clinically significant decrease in pulmonary vein diameter or an increase in Vmax were seen at one month post-ablation. Non-significant asymptomatic left superior pulmonary vein stenosis was demonstrated in two patients. These pa-tients had follow-up transesophageal echocardiography (TEE) at 6 months and later, with the above parameters shown to be stationary. Transesophageal 3D reconstruction confirmed non-significant stenosis in one patient and non-significant thickening of the left superior pulmonary vein wall without changes in flow rates and diameter in the other patient.

Conclusion:
Catheter radiofrequency ablation for atrial fibrillation with pulmonary vein isolation using electroanatomically navigated circumscribed lesions is associated with minimal risk for developing pulmonary vein stenosis. Transesophageal echocardiography is a most valuable method, particularly because of its potential for functional assessment of pulmonary vein flow rates.

Keywords: Atrial fibrillation; Catheter radiofrequency ablation; Pulmonary vein isolation; Pulmonary vein stenosis; Transesophageal echocardiography

Published: January 1, 2006  Show citation