Pulmonary Venous Flow Assessed by Doppler Echocardiography in the Management of Atrial Fibrillation

Abstract

Pulmonary venous blood flow (PVF) visualized by Doppler echocardiography exhibits a pulsatile behavior, which is related to left atrial pressure and function, mitral valve function, and left ventricular compliance. In atrial fibrillation (AF), the disappearance of atrial reverse flow, a decrease in systolic flow with a greater diastolic than systolic flow, a prolonged onset of systolic flow and the appearance of an early systolic reverse flow are characteristic findings. A reduction in systolic PVF expressed by reduced peak velocity, reduced velocity-time integral of systolic flow, and reduced systolic fraction of PVF has been found to be associated with reduced left atrial appendage flow, left atrial spontaneous echo contrast formation, frequency of AF paroxysms and propensity for AF recurrence following restoration of sinus rhythm. Ablation techniques targeting pulmonary vein ostia and adjacent left atrium are promising treatment options to cure AF. Monitoring the PVF response to and adjusting of ablation procedures has been suggested to optimize outcome and prevent complications such as pulmonary vein stenosis. In conclusion, assessment of PVF variables and patterns by Doppler echocardiography seems useful in the management of AF patients. Especially the reduction in systolic PVF may be used as marker for left atrial dysfunction which favors thrombus formation and AF reinitiation. Finally, PVF monitoring has the potential to an increasing role in AF ablation procedures.

Left Atrial Appendage Flow Velocity and Time from P‐Wave Onset to Tissue Doppler–Derived A' Predict Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation

“…Conversely, Yoshida et al 26 found a good correlation between LAAFV and LA wall contraction velocity. 30,31 However, mitral inflow is thought to be affected by age and hemodynamic loading conditions. Antonielli et al 29 also found that a higher LAAFV was associated with better maintenance of SR after cardiover-sion.…”

“…Some studies assessed atrial systolic function using mitral inflow and PV flow. 30,31 However, mitral inflow is thought to be affected by age and hemodynamic loading conditions. 32,33 This study found no difference in the mitral inflow A-wave between patients with and without AF recurrence.…”

In vivo Bioimaging as a Novel Strategy to Detect Doxorubicin-Induced Damage to Gonadal Blood Vessels

“…Following a short stabilization period, a baseline femoral or testicular arterial blood flow was recorded by the PW Doppler mode during a 50 second cine loop and quantified by analyzing the Velocity-Time Integral (VTI) [15]-[18]. When the PW Doppler mode curve is integrated, it yields a VTI that indicates the distance the blood travels during a certain cardiac circle.…”

Correlation between N-Terminal Pro-Brain Natriuretic Peptide and Doppler Echocardiographic Parameters of Left Ventricular Filling Pressure in Atrial Fibrillation

“…Those patterns of pulmonary venous blood flow changes are related with LA dysfunction, mainly in atrial relaxation, compliance, and reservoir function 15). Assessment of pulmonary venous blood flow variables and patterns by Doppler echocardiography seems useful in the management of AF patients 16). Especially, the reduction in systolic pulmonary venous blood flow may be used as marker for LA dysfunction which favors thrombus formation and AF reinitiation 16)…”