Transesophageal echocardiography: a screening method for pulmonary vein stenosis after catheter ablation of atrial fibrillation.
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.
Schneider
Carsten
C
Department of Cardiology, AK St. Georg General Hospital, II. Med. Abteilung (Kardiologie), Lohmühlenstrasse 5, 20099 Hamburg, Germany.
Ernst
Sabine
S
Bahlmann
Edda
E
Malisius
Rainer
R
Krumsdorf
Ulrike
U
Boczor
Sigrid
S
Lampe
Friedrun
F
Hoffmann-Riem
Martin
M
Kuck
Karl-Heinz
KH
Antz
Matthias
M
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