Role of Echocardiography in Pulmonary Vein Ablation for Atrial Fibrillation

Background: Previous studies suggest that wide area circumferential pulmonary vein ablation (WACA) is more effective than segmental pulmonary vein ablation (SPVA) for pulmonary vein isolation (PVI) for treatment of atrial fibrillation. Whether this is true in patients (pts) with very short duration paroxysmal atrial fibrillation (PAF) is unknown. Objective: To compare WACA to SPVA in pts with PAF lasting <48 hours. Methods: One hundred pts with PAF <48 hours were randomized to either WACA vs SPVA (45 and 53 pts respectively, with 2 withdrawals), and followed up for 24 months with 14-day ECGs every 6 months. Results: Among 97 pts at an average of 22.1±4.8 months followup, 26 (57.8%) remained free of any atrial arrhythmias after WACA versus 29 (55.86%) after SPVA (p=0.64). Sixteen pts (35.6%) had recurrent PAF after WACA versus 20 pts (38.5%) after SPVA (p=0.79). Seven pts (15.6%) had atrial flutter after WACA versus 5 pts (9.64%) after SPVA (p=0.376) and 1 pt (2.2%) had atrial tachycardia after WACA vs 1 pt (1.9%) after SPVA (p=0.918). Total procedure time was lower for SPVA vs WACA (242.9 vs 271.1 minutes, p= 0.047), and fluoroscopy time similar for WACA vs SPVA (50.8 vs 53.4 minutes, p=0.555). Conclusions: As an initial ablation approach in pts with PAF <48 hours, SPVA was similarly effective to WACA with respect to arrhythmia recurrence, supporting the central role of the pulmonary veins for maintaining AF in these pts. Future therapies using alternative ablation energies may incorporate these insights to reduce risk to gastroesophageal structures.

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Role of Transesophageal Echocardiography Compared to Computed Tomography in Evaluation of Pulmonary Vein Ablation for Atrial Fibrillation (ROTEA Study)

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2011.05.014 ◽

2011 ◽

Vol 24 (9) ◽

pp. 1046-1055 ◽

Cited By ~ 14

Author(s):

Andrew C.Y. To ◽

Ruvin S. Gabriel ◽

Margaret Park ◽

Boris S. Lowe ◽

Ronan J. Curtin ◽

...

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Transesophageal Echocardiography ◽

Pulmonary Vein ◽

Pulmonary Vein Ablation

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2677 Circumferential pulmonary vein ablation in patients with atrial fibrillation and associated systolic or diastolic heart failure

European Heart Journal ◽

10.1016/s0195-668x(03)95459-5 ◽

2003 ◽

Vol 24 (5) ◽

pp. 494 ◽

Cited By ~ 1

Author(s):

C PAPPONE

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Pulmonary Vein ◽

Diastolic Heart Failure ◽

Pulmonary Vein Ablation

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Anatomical correlation between left atrium pulmonary vein ablation targets of atrial fibrillation and adjacent bronchi and pulmonary arteries by MSCT

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01881-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yan-Jing Wang ◽

Huan Sun ◽

Xiao-Fei Fan ◽

Meng-Chao Zhang ◽

Ping Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Vein ◽

Pulmonary Arteries ◽

Contact Points ◽

Pulmonary Vein Ablation ◽

Adjacent Structures ◽

Anatomical Correlation ◽

The Right

Abstract Background The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical correlation between left atrium (LA)-pulmonary vein (PV) and adjacent structures. Methods Data were collected from 126 consecutive patients using coronary artery CT angiography. The LA roof was divided into three layers and nine points. The minimal spatial distances from the nine points and four PV orifices to the adjacent bronchi and PAs were measured. The distances from the PV orifices to the nearest contact points of the PVs, bronchi, and PAs were measured. Results The anterior points of the LA roof were farther to the bronchi than the middle or posterior points. The distances from the nine points to the PAs were shorter than those to the bronchi (5.19 ± 3.33 mm vs 8.62 ± 3.07 mm; P < .001). The bilateral superior PV orifices, especially the right superior PV orifices were closer to the PAs than the inferior PV orifices (left superior PV: 7.59 ± 4.14 mm; right superior PV: 4.43 ± 2.51 mm; left inferior PV: 24.74 ± 5.26 mm; right inferior PV: 22.33 ± 4.75 mm) (P < .001). Conclusions The right superior PV orifices were closer to the bronchi and PAs than other PV orifices. The ablation at the mid-posterior LA roof had a higher possibility to damage bronchi. CT is a feasible method to assess the anatomical adjacency in vivo, which might provide guidance for AF ablation.

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