Identification of atrial tissue in pulmonary veins using intravascular ultrasound.
BACKGROUND
Atrial fibrillation (AF) is initiated by ectopic beats originating in the sleeve of atrial tissue in pulmonary veins (PVs). Circumferential ablation of PVs can, thus, result in a cure of AF. Identification of this PV arrhythmogenic tissue has been exclusively on the basis of electrophysiologic recordings. The purpose of this study was to visualize this tissue using intravascular ultrasound (IVUS). Methods and results In all, 15 patients undergoing AF ablation had IVUS studies of their PVs. A total of 21 veins had a wall thickness less than 0.1 mm, whereas 31 veins had well-demarcated areas of thickening measuring 0.81 +/- 0.32 mm. Electrophysiologic recordings from these thickened areas showed typical high-frequency potentials associated with arrhythmogenic atrial tissue in the PVs. Ectopic beats initiating AF always originated from these areas. PVs without thickening on IVUS did not have these potentials.


CONCLUSIONS
IVUS permits visualization of atrial tissue in the PVs, and arrhythmogenic PVs are qualitatively and quantitatively different from nonarrhythmogenic PVs.
Guerra
Peter G
PG
Department of Medicine, Montreal Heart Institute.
Thibault
Bernard
B
Dubuc
Marc
M
Talajic
Mario
M
Roy
Denis
D
Crépeau
Jacques
J
Nattel
Stanley
S
Tardif
Jean-Claude
JC
D000200:Action Potentials; D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery; D018880:Atrial Premature Complexes / Q000175:diagnosis / Q000601:surgery; D017115:Catheter Ablation; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000601:surgery; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional