title: Transesophageal echocardiographic follow-up of pulmonary veins in patients undergoing ostial radiofrequency catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  Ostial radiofrequency catheter ablation (RFCA) of pulmonary veins (PVs) is a promising invasive approach for the non-pharmacologic treatment of atrial fibrillation, but PV stenosis has been reported as a possible complication of this intervention. The aim of this study was to assess PV anatomy and stenosis (i.e. number and progression) by means of transesophageal echocardiography (TEE) during the follow-up of patients undergoing RFCA.
  
  
  METHODS
  Twenty-three consecutive patients with refractory and highly symptomatic atrial fibrillation underwent ostial radiofrequency isolation of arrhythmogenic triggers/foci, localized into the PVs, by an electroanatomic approach (CARTO system) or circular mapping with a multipolar catheter (LASSO) placed under radioscopic guidance. All patients were investigated using TEE and magnetic resonance angiography before radiofrequency application to evaluate PV anatomy. TEE examination was repeated after 2 months of follow-up and, in the presence of a stenosis, 1 year later.
  
  
  RESULTS
  TEE allowed to identify 100% of the left and right superior PVs, 96% of right inferior PVs, and 74% of the left inferior PVs. Anatomic variants were detected at TEE in 33% of patients against 37% at magnetic resonance angiography (95% of concordance). After ostial RFCA, TEE disclosed a significant reduction in the mean diameters of the left superior PV (14.1 +/- 3.2 vs 12.0 +/- 2.7 mm, p < 0.01), left inferior PV (11.2 +/- 2.3 vs 9.8 +/- 2.2 mm, p = 0.05) and right superior PV (14.2 +/- 2.6 vs 12.9 +/- 2.7 mm, p < 0.05), and an increase in the mean peak velocities of the left superior PV (69.8 +/- 14.8 vs 91 +/- 42.4 cm/s, p < 0.05) and left inferior PV (59.2 +/- 18.1 vs 79.3 +/- 40.5 cm/s, p < 0.05). From a total of 88 PVs treated, 7 (7.9%) showed a higher significant stenosis in patients treated using the LASSO than the CARTO system (31.3 vs 2.8% respectively, p < 0.01). After 1-year follow-up there was no progression of PV stenosis.
  
  
  CONCLUSIONS
  TEE was successful to evaluate PV anatomy and stenosis of patients undergoing ostial RFCA for atrial fibrillation. This complication is not rare and seems to be strictly related to the method of ablation, in particular when circular mapping and disconnection of triggers/foci was carried out by only a circular multipolar catheter without an electroanatomic approach.
authors.affiliation: Department of Cardiology, P. Cosma Hospital, Camposampiero (PD), Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Artuso
authors.forename: Berardino
authors.initials: B
authors.lastname: Stomaci
authors.forename: Roberto
authors.initials: R
authors.lastname: Verlato
authors.forename: Pietro
authors.initials: P
authors.lastname: Turrini
authors.forename: Nicolò
authors.initials: N
authors.lastname: Lafisca
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Baccillieri
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Marco
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Piovesana
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D003251:Constriction, Pathologic; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000473:pathology