title: Dilatation of the pulmonary veins in atrial fibrillation: a transesophageal echocardiographic evaluation.
abstract: Ectopic beats originating from sleeves of atrial tissue within the pulmonary veins (PVs) can induce and sustain paroxysmal atrial fibrillation (AF). Left atrial stretch and dilatation favors the development of atrial ectopy and AF. Similarly, PV dilatation, if present, might trigger PV ectopy in patients with AF. This study was designed to evaluate whether PV dilatation is present in patients with nonfocal AF and whether the PV diameter correlates to the left atrial diameter (LAD). The diameters of the right superior (RSPV) and left superior PV (LSPV) were measured at the ostium and at a depth of 1 cm in 170 patients (AF, n = 75; sinus rhythm [SR], n = 95) using transesophageal echocardiography. The LAD was determined by transthoracic echocardiography. The diameters of the PVs were significantly larger in patients with AF than in patients with SR (LSPV(ostium): AF 13.6 +/- 3.5 mm vs SR 10.6 +/- 2.7 mm, P < 0.001; LSVP(1cm): AF 12.5 +/- 2.9 mm vs SR 10.2 +/- 2.5 mm, P < 0.001; RSPV(ostium): AF 13.9 +/- 3.5 mm vs SR 11.7 +/- 2.9 mm, P < 0.001; RSVP(1cm): AF 12.8 +/- 2.8 mm vs SR 10.6 +/- 2.6 mm, P < 0.05). Similarly, LAD was larger in patients with AF (44.7 +/- 7.7 mm) as compared to patients with SR (38.8 +/- 6.8 mm, P < 0.001). Neither for the SR nor the AF group did the PV size correlate to the LAD. AF is associated with a significant enlargement of the RSPV, LSPV, and LAD. There is no correlation between LAD and PV diameters. This raises the question whether PV dilatation in patients with AF is a cause or a consequence of AF and whether it may contribute to the development and perpetuation of AF.
authors.affiliation: Technical University RWTH Aachen, Department of Cardiology, Aachen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Knackstedt
authors.forename: Laurent
authors.initials: L
authors.lastname: Visser
authors.forename: Jurgita
authors.initials: J
authors.lastname: Plisiene
authors.forename: Markus
authors.initials: M
authors.lastname: Zarse
authors.forename: Matthias
authors.initials: M
authors.lastname: Waldmann
authors.forename: Karl
authors.initials: K
authors.lastname: Mischke
authors.forename: Karl-Christian
authors.initials: KC
authors.lastname: Koch
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Franke
authors.forename: Peter
authors.initials: P
authors.lastname: Hanrath
authors.forename: Patrick
authors.initials: P
authors.lastname: Schauerte
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000473:pathology*; D004108:Dilatation, Pathologic; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology*