Comparison of transthoracic echocardiography with computed tomography in evaluation of pulmonary veins

Abstract

BackgroundTransesophageal echocardiography may be used to assess pulmonary veins for atrial fibrillation ablation. No study focused on the role of transthoracic echocardiography (TTE) in evaluating the diameter and anatomy of pulmonary veins.MethodsAmong 142 atrial fibrillation patients (57.7% men; mean age, 60.5) hospitalised for catheter ablation, we assessed pulmonary veins and compared the measurements by TTE with cardiac computed tomography (CT) before ablation. Among 17 patients who had follow-up examinations, the second measurements were also studied.ResultsTTE identified and determined the diameters of 140 (98.6%) right and 140 (98.6%) left superior PVs, and 136 (95.7%) right and 135 (95.1%) left inferior PVs. A separate middle PV ostia was identified in 14 out of the 22 patients (63.6%) for the right side and in 2 out of 4 (50.0%) for the left side. The PV diameters before ablation assessed by CT vs. TTE were 17.96 vs. 18.07 mm for right superior, 15.92 vs. 15.51 mm for right inferior, 18.54 vs. 18.42 mm for left superior, and 15.56 vs. 15.45 mm for left inferior vein. The paired differences between the assessments of CT and TTE were not significant (P ≥ 0.31) except for the right inferior vein with a CT-minus-TTE difference of 0.41 mm (P = 0.018). The follow-up PV diameters by both CT (P ≥ 0.069) and TTE (P ≥ 0.093) were not different from baseline measurements in the 17 patients who had follow-up measurements.ConclusionsWith a better understanding of PV anatomy in TTE imaging, assessing PV diameters by non-invasive TTE is feasible. However, the clear identification of anatomic variation might still be challenging.

Local Electrical Impedance Mapping of the Atria: Conclusions on Substrate Properties and Confounding Factors

“…In contrast, the LI inside the PVs exceeded the LI in the remaining atrium presumably due to the smaller lumen and different substrate of the PVs as previously shown in impedance studies with generator impedance setups (Vaseghi et al, 2005 ). With the inferior PVs usually being smaller in diameter than the superior PVs (Dong et al, 2019 ), the smaller lumen could also explain higher LI values in the inferior PVs compared to the superior PVs.…”

Computed tomography and transthoracic echocardiography for assessment of left ventricle geometry in patients with aortic valve stenosis

“…Beside radiation exposure and the necessity of contrast agent usage, computed tomography is a safe examination. In some cases cardiac computed tomography can be considered superior to echocardiography for detailed morphological observations as it produces the exemplary representation of cardiac structure [9,[11][12][13][14][15]. Moreover, the implementation of some modifications to the acquisition protocol and post-processing workup (especially the utilization of three-dimensional tools) may benefit in more accurate assessment of left ventricle geometry and its global function.…”

Impact of pulmonary vein ovality index on cooling kinetics and acute success of atrial fibrillation ablation with the third-generation cryoballoon catheter

“…Therefore, the evaluation of PV anatomy appears reasonable to adequately plan the procedure. Regarding the correlation between CT imaging and transesophageal echocardiography, TEE-based pre-procedural PV assessment if feasible; however, it again can be challenging with clear identification of anatomical variants [37].…”