title: Transesophageal echocardiography: a screening method for pulmonary vein stenosis after catheter ablation of atrial fibrillation.
abstract: OBJECTIVE
  Pulmonary vein (PV) stenosis has been described as a complication after catheter ablation of atrial fibrillation. The aim of the study was to investigate the diagnostic role of transesophageal echocardiography (TEE) in the assessment of PV stenosis.
  
  
  METHODS
  Ninety-one patients (71 men, mean age 57+/-16years), initially treated by catheter ablation of atrial fibrillation, underwent re-ablation because of arrhythmia recurrences. PV angiograms and TEE were performed before the first and second ablation. PVs were analysed in an intraindividual comparison by measurements of mean and peak flow velocity and of velocity time integrals and diameters. PV angiograms served as standard for assessment of PV stenosis.
  
  
  RESULTS
  Sixteen of 91 patients developed PV stenoses as a consequence of the first ablation (13 mild PV stenoses, 4 moderate PV stenoses). All patients with PV stenosis were asymptomatic. In moderate PV stenosis (50-70%) a significant increase of blood flow parameters, reduction of vessel diameter, inhomogeneous blood flow and aliasing were demonstrated by TEE. Using quantitative TEE criteria moderate PV stenosis could be identified with a sensitivity of 84% and specificity of 98%. Detection of mild PV stenosis (30-50%) is challenging (sensitivity of 48% and specificity of 75%).
  
  
  CONCLUSIONS
  TEE identifies significant PV stenosis by assessment of flow characteristics and vessel diameter and can thereby be used as a follow-up tool after catheter ablation of atrial fibrillation.
authors.affiliation: Department of Cardiology, AK St. Georg General Hospital, II. Med. Abteilung (Kardiologie), Lohmühlenstrasse 5, 20099 Hamburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schneider
authors.forename: Sabine
authors.initials: S
authors.lastname: Ernst
authors.forename: Edda
authors.initials: E
authors.lastname: Bahlmann
authors.forename: Rainer
authors.initials: R
authors.lastname: Malisius
authors.forename: Ulrike
authors.initials: U
authors.lastname: Krumsdorf
authors.forename: Sigrid
authors.initials: S
authors.lastname: Boczor
authors.forename: Friedrun
authors.initials: F
authors.lastname: Lampe
authors.forename: Martin
authors.initials: M
authors.lastname: Hoffmann-Riem
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Matthias
authors.initials: M
authors.lastname: Antz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D019233:Retreatment; D012680:Sensitivity and Specificity