title: Transesophageal echocardiographic assessment of pulmonary veins and left atrium in patients undergoing atrial fibrillation ablation.
abstract: BACKGROUND
  Pulmonary vein (PV) antrum isolation with ganglionated plexi (GP) ablation is a novel atrial fibrillation (AF) ablation technique. The aim of this study was to evaluate acute changes in left atrial and PV flow velocities following PV antrum isolation with GP ablation using transesophageal echocardiography (TEE).
  
  
  METHODS
  TEE was performed before and after PV antrum isolation with GP ablation in 88 consecutive patients. All four PVs, when possible, were analyzed with regard to peak systolic and diastolic pulsed-wave Doppler flow velocities. Left atrial appendage emptying velocities were also obtained. PV stenosis was defined as a peak PV Doppler flow velocity of ≥110 cm/sec with spectral broadening (turbulence).
  
  
  RESULTS
  All but four right inferior and four left inferior PVs were visualized. Compared to preablation values, both PV systolic and diastolic velocities increased after ablation (P < 0.05 for each of the four PVs). However, the systolic to diastolic ratio decreased significantly after ablation in all PVs (1.3 ± 0.6 to 0.9 ± 0.4, P < 0.0001, 1.2 ± 0.7 to 0.9 ± 0.4, P < 0.0001, 1.2 ± 0.6 to 1.0 ± 0.6, P = 0.035 and 1.1 ± 0.5 to 0.9 ± 0.5, P = 0.0001, for left superior, left inferior, right superior and right inferior PV, respectively). Left atrial appendage emptying velocities showed a trend towards higher values following ablation (62.7 ± 26.1 cm/sec vs. 67.5 ± 23.2 cm/sec, P = 0.07). Asymptomatic PV stenosis occurred in seven patients (seven PVs).
  
  
  CONCLUSIONS
  PV antrum isolation with GP ablation acutely increased PV flow velocities and altered the pattern of PV Doppler flow signal, likely correlating with increased left atrial pressures, but did not appear to adversely impact on left atrial appendage physiology.
authors.affiliation: Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors.forename: Stavros
authors.initials: S
authors.lastname: Stavrakis
authors.forename: George
authors.initials: G
authors.lastname: Madden
authors.forename: Dipesh
authors.initials: D
authors.lastname: Pokharel
authors.forename: Sunny S
authors.initials: SS
authors.lastname: Po
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Warren M
authors.initials: WM
authors.lastname: Jackman
authors.forename: Chittur A
authors.initials: CA
authors.lastname: Sivaram
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity; D017115:Catheter Ablation / Q000379:methods*; D015897:Comorbidity; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation