Transesophageal echocardiography: a follow-up tool after catheter ablation of atrial fibrillation and interventional therapy of pulmonary vein stenosis and occlusion.
BACKGROUND
Pulmonary vein stenosis (PVS) has been described as a complication after primary catheter ablation of atrial fibrillation (Afib). The purpose of this study was to evaluate the utility of transesophageal echocardiography (TEE) as follow-up tool after catheter ablation of Afib and interventional therapy of PVS and pulmonary vein occlusion (PVO).


METHODS
We report on 28 patients with stenosis (PVS) of 33 pulmonary veins (PVs) and total PVO of 4 veins complicating ablation of Afib assessed by angiography and/or magnetic resonance imaging (MRI). Subsequently, transseptal PV angiograms were performed, followed by recanalization of three totally occluded PVs and balloon dilatation of seven severe PVS (in four cases combined with PV stenting). PVs were analyzed by multiplane TEE in an intraindividual comparison of preablation/preintervention and follow-up measurements of mean and peak flow velocity, velocity time integrals, and diameters.


RESULTS
Of a total of 28 patients, 14 had mild PVS (n = 14), 9 had moderate PVS (n = 10), 6 had severe PVS (n = 8), and 4 patients showed totally occluded PVs (n = 4). In multivariate analysis flow velocities and vessel diameters showed significant differences (mild, moderate, and severe PVS and PVO; p = 0.001). Interventional benefits of balloon dilatation (n = 10) and stent implantation (n = 4), as well as in-stent restenosis could be detected (p = 0.014). In all recanalized vessels TEE showed reestablished flow. In occluded PVs no flow was detectable. The TEE vessel diameters correlated with angiography data (r = 0.87) and computed tomography/MRI (r = 0.90).


CONCLUSIONS
TEE can be used as a follow-up tool after interventional therapy in patients after catheter ablation and acquired PVS/PVO. Restenosis/in-stent restenosis can be identified by analyzing the vessel diameters and blood flow characteristics.
Schneider
Carsten
C
Department of Cardiology, St. Georg Hospital, Lohmühlenstrasse 5, Hamburg, Germany. Dr_C_Schneider@hotmail.com
Ernst
Sabine
S
Malisius
Rainer
R
Bahlmann
Edda
E
Lampe
Friedrun
F
Broemel
Thomas
T
Krause
Korff
K
Boczor
Sigrid
S
Antz
Matthias
M
Kuck
Karl-Heinz
KH
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D015641:Radiography, Interventional