Use of intracardiac echocardiography for prediction of chronic pulmonary vein stenosis after ablation of atrial fibrillation.
BACKGROUND
Measurements of pulmonary vein (PV) flow with intracardiac echocardiography (ICE) immediately before and after PV isolation may be a useful method for predicting which patients will develop chronic PV stenosis.


RESULTS
We assessed preablation and postablation flows in each of the four PVs using a phase-array ICE catheter in 95 patients (mean age 52 +/- 13) undergoing atrial fibrillation ablation. The ostium of each of the PVs was defined using angiography, electrical mapping, and ICE imaging. Ostial electrical isolation of all PVs was achieved using a 4-mm cooled-tip radiofrequency ablation catheter. Change in PV flow, when present, was examined as both an absolute value and as a percentage of the baseline flow. All patients underwent spiral computed tomography (CT) scans of the PVs 3 months after the procedure for detection of stenosis. The average preablation diastolic flows for the left superior, left inferior, right superior, and right inferior veins were 0.56, 0.54, 0.47, and 0.45 m/sec, respectively. These values increased to 0.74, 0.67, 0.58, and 0.59 m/sec postablation (P < 0.001). Of 380 PVs ablated, the CT scans revealed 2 (1%) with severe (>70%) stenosis, 13 (3%) with moderate (51%-70%) stenosis, and 62 (16%) with mild (< or = 50%) stenosis. The r value between flow and stenosis was only 0.09 (P = NS).


CONCLUSIONS
Acute changes in PV flow immediately after ostial PV isolation do not appear to be a strong predictor of chronic PV stenosis.
Saad
Eduardo B
EB
Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Ohio 44195, USA.
Cole
Christopher R
CR
Marrouche
Nassir F
NF
Dresing
Thomas J
TJ
Perez-Lugones
Alejandro
A
Saliba
Walid I
WI
Schweikert
Robert A
RA
Klein
Allan
A
Rodriguez
Leonardo
L
Grimm
Richard
R
Tchou
Patrick
P
Natale
Andrea
A
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D001783:Blood Flow Velocity / Q000502:physiology; D017115:Catheter Ablation; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D012086:Reoperation; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome