A transthoracic echocardiographic follow-up study after catheter ablation of atrial fibrillation: can we detect pulmonary vein stenosis by transthoracic echocardiography?
OBJECTIVE
While pulmonary vein isolation (PVI) is an effective curative procedure for patients with atrial fibrillation (AF), pulmonary vein (PV) stenosis is a potential complication which may lead to symptoms that are often unrecognized. The aim of this study was to compare differences between ablation sites in pulmonary venous flow (PVF) measured by transthoracic Doppler echocardiography (TTE) before and after PVI.


METHODS
ONE HUNDRED FIVE PATIENTS (M : F=64 : 41; mean age 56±10 years) with paroxysmal AF (n=78) or chronic, persistent AF (n=27) were enrolled. PVI strategies consisted of ostial ablation (n=75; OA group) and antral ablation using an electroanatomic mapping system (n=30; AA group). The ostial diameter was estimated by magnetic resonance imaging (MRI) in patients with PVF ≥110 cm/sec by TTE after PVI.


RESULTS
No patient complained of PV stenosis-related symptoms. Changes in mean peak right PV systolic (-6.7±28.1 vs. 10.9±25.9 cm/sec, p=0.038) and diastolic (-4.1±17.0 vs. 9.9±25.9 cm/sec, p=0.021) flow velocities were lower in the AA group than in the OA group. Although the change in mean peak systolic flow velocity of the left PV before and after PVI in the AA group was significantly lower than the change in the OA group (-13.4±25.1 vs. 9.2±22.3 cm/sec, p=0.016), there was no difference in peak diastolic flow velocity. Two patients in the OA group had high PVF velocities (118 cm/sec and 133 cm/sec) on TTE, and their maximum PV stenoses measured by MRI were 62.5% and 50.0%, respectively.


CONCLUSIONS
PV stenosis after PVI could be detected by TTE, and PVI by antral ablation using an electroanatomic mapping system might be safer and more useful for the prevention of PV stenosis.
Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Dong-Hyeon
DH
Lee
Yong-Seog
YS
Oh
Woo-Seung
WS
Shin
Ji-Hoon
JH
Kim
Yun-Seok
YS
Choi
Sung-Won
SW
Jang
Chul-Soo
CS
Park
Ho-Joong
HJ
Youn
Man-Young
MY
Lee
Wook-Sung
WS
Chung
Ki-Bae
KB
Seung
Tai-Ho
TH
Rho
Jae-Hyung
JH
Kim
Kyu-Bo
KB
Choi