Transoesophageal echocardiographic evaluation of pulmonary vein anatomy in patients undergoing ostial radiofrequency catheter ablation for atrial fibrillation: a comparison with magnetic resonance angiography

Toffanin, Gianluca; Scarabeo, Virginia; Verlato, Roberto; Conti, Fabio; Zampiero, A.; Piovesana, Piergiuseppe

doi:10.2459/01.jcm.0000247322.57536.04

Cited by 18 publications

(12 citation statements)

References 31 publications

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“…Recently, it has been shown that ectopic electrical activity in the sleeves of atrial myocardium extending 1-2 cm into the pulmonary veins (PVs) plays a central role in generating AF [4][5][6]. Th us, since the discovery that ectopic foci can originate in PVs and can be responsible for AF, pulmonary veins themselves became the targets of catheter directed radiofrequency ablation [7,8].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography

Tekbaş

Gümüş

Önder

et al. 2011

Wien Klin Wochenschr

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Section: Discussionmentioning

confidence: 99%

Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography

Tekbaş

Gümüş

Önder

et al. 2011

Wien Klin Wochenschr

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“…The ratio between the vein size and the balloon size seems to play a crucial role in the appearance of this complication [15] , [16] . TEE has been reported as strongly correlated to magnetic resonance (MR) angiography in assessing PV anatomy [17] , and Peyrol et al [18] suggested that TEE was an easily available and effective tool to select the cryoballoon size for PVI according to evaluated PV diameters and anatomy. Instead of using MR angiography for evaluating the PV diameter and selecting the cryoballoon size, we think that it is reasonable to use TEE.…”

Section: Discussionmentioning

confidence: 99%

Impact of transesophageal echocardiography during transseptal puncture on atrial fibrillation ablation

Erden

Gölcük

et al. 2016

Journal of Arrhythmia

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BackgroundThe aim of our study was to demonstrate the added value of routine transesophageal echocardiography (TEE) for correctly positioning the transseptal system in the fossa ovalis (FO), thus potentially preventing complications during fluoroscopy-guided transseptal puncture (TP), and for assessing the optimal puncture site within the FO according to the expected procedure type.MethodsNinety-one patients undergoing pulmonary vein isolation (PVI) procedures by cryoballoon technique for drug-resistant paroxysmal or persistent atrial fibrillation (AF) were prospectively included. In 57 patients, the TP procedure was performed under fluoroscopic guidance and septal localization was confirmed by contrast injection through the needle and demonstration of septal tenting in both the anteroposterior and left lateral fluoroscopic projections. In 34 patients, TP was performed under TEE guidance and positioning was targeted to perform the TP procedure in the more anterior and inferior locations of the FO. Two patient groups were compared according to the incidence of complications directly attributable to transseptal catheterization, thromboembolic complications, recurrence rates after the ablation procedure, total procedural time, and fluoroscopy time.ResultsFluoroscopy time (p<0.001), total cryoablation time (p=0.002), and total procedural time (p<0.001) were shorter in the TEE-guided group. Left inferior pulmonary vein (LIPV) cryoablation time (p=0.007) and right inferior pulmonary vein (RIPV) cryoablation time (p=0.004) were significantly shorter and the number of applications to the LIPV (p=0.007) and RIPV (p=0.005) were significantly fewer in the TEE-guided group. Although there was a trend toward higher complication rates (20.6% vs. 31.6%, p=0.37) and recurrence rates (11.8% vs. 20.1%, p=0.26) in the fluoroscopy-guided group, the differences between the groups were not statistically significant.ConclusionsTEE-guided TP for AF ablation is associated with shorter fluoroscopy time, shorter total cryoablation time, and shorter total procedural time. Importantly, TEE-guided TP facilitates cryoablation of the inferior pulmonary veins.

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“…There are comparative data between modalities (37,38), but no study integrates all imaging modalities so a complete comparison is lacking. However, cardiac CT and CMR provide superior spatial resolution over ultrasound (39,40), and can also be co-registered with electroanatomical mapping systems (9). Each has advantages and disadvantages.…”

Section: Discussionmentioning

confidence: 99%

The Incidence, Pattern, and Prognostic Value of Left Ventricular Myocardial Scar by Late Gadolinium Enhancement in Patients With Atrial Fibrillation

Neilan

Shah

Abbasi

et al. 2013

Journal of the American College of Cardiology

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Objectives We aimed to identify the frequency, pattern, and prognostic significance of left ventricular (LV) late gadolinium enhancement (LGE) in patients with atrial fibrillation (AF). Background There are limited data on the presence, pattern, and prognostic significance of LV myocardial fibrosis in patients with AF. Late gadolinium enhancement during cardiac magnetic resonance (CMR) is a marker for myocardial fibrosis. Methods We studied a consecutive group of 664 patients without known prior myocardial infarction being referred for radiofrequency ablation of AF. CMR was requested to assess pulmonary venous anatomy. Results Overall, 73% were male, with an average age of 56 years, and an ejection fraction of 55±10%. Left ventricular LGE was found in 88 patients (13%). The endpoint was all-cause mortality, and in this cohort we observed 68 deaths over a median follow-up period of 42 months. On univariable analysis, age (HR 1.05, CI 1.03–1.08, LRχ2 15.2, p=0.0001), diabetes (HR 2.39, CI 1.41–4.09, LRχ210.3, p=0.001), a history of heart failure (HR 1.78, CI 1.09–2.91, LRχ2 5.37, p=0.02), left atrial dimension (HR 1.04, CI 1.01–1.08, LRχ2 6.47, p=0.01), presence of LGE (HR 5.08, CI 3.08–8.36, LRχ2 28.8, p<0.0001), and LGE extent (HR 1.15, CI 1.10–1.21, LRχ2 35.6, p<0.0001) provided the strongest association with mortality. The mortality rate was 8.1% per patient-years in patients with LGE vs. 2.3% patients without LGE. In the best overall multivariable model for mortality, age and the extent of LGE were independent predictors of mortality. Indeed, each 1% increase in LGE associated with a 15% increased risk of death. Conclusions In patients with AF, LV LGE is a frequent finding and is a powerful predictor of mortality.

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Transoesophageal echocardiographic evaluation of pulmonary vein anatomy in patients undergoing ostial radiofrequency catheter ablation for atrial fibrillation: a comparison with magnetic resonance angiography

Cited by 18 publications

References 31 publications

Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography

Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography

Impact of transesophageal echocardiography during transseptal puncture on atrial fibrillation ablation

The Incidence, Pattern, and Prognostic Value of Left Ventricular Myocardial Scar by Late Gadolinium Enhancement in Patients With Atrial Fibrillation

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