Transesophageal echocardiography: A follow-up tool after catheter ablation of atrial fibrillation and interventional therapy of pulmonary vein stenosis and occlusion

Schneider, Carsten; Ernst, Sabine; Malisius, Rainer; Bahlmann, Edda; Lampe, Friedrun; Broemel, Thomas; Krause, Korff; Boczor, Sigrid; Antz, Matthias; Kück, Karl‐Heinz

doi:10.1007/s10840-007-9085-1

Cited by 21 publications

(15 citation statements)

References 38 publications

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“…Five studies used the peak PV Doppler flow velocity to define PV stenosis by TEE, although the cutoff value varied from 0.9 m/s in one study, 17 1.0 m/s in one study 15 and 1.1 m/s in three studies, 14,24,25 with two studies in the latter group also requiring the presence of turbulent Doppler flow signal 14,24 . The presence of turbulent Doppler flow signal was noted in two other studies, 16,17 although this was not required for the definition of PV stenosis. In another study, 25 a 100% increase in the peak PV Doppler flow velocity was noted between the pre‐ and postablation TEE.…”

Section: Resultsmentioning

confidence: 99%

“…In another study, 25 a 100% increase in the peak PV Doppler flow velocity was noted between the pre‐ and postablation TEE. Two studies 16,23 only included patients with known PV stenosis (case series) and did not use a formal definition of PV stenosis by TEE, but included enough data to calculate sensitivity and specificity using an arbitrary cutoff value of the peak PV Doppler flow velocity of 1.1 m/s (the most frequently used cutoff value in other studies). At least 96% of the PVs were visualized by TEE.…”

Section: Resultsmentioning

confidence: 99%

“…A narrowing of PV luminal diameter of 50% or more compared to preablation or adjacent normal values detected by the reference standard was an indication of a stenosis. This cutoff value corresponds to moderate (50–70%) and severe (>70%) stenosis 16,17 . Mild PV stenosis (<50%) was not considered clinically significant and therefore was not included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

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Transesophageal Echocardiography for the Diagnosis of Pulmonary Vein Stenosis after Catheter Ablation of Atrial Fibrillation: A Systematic Review

Stavrakis¹,

Madden²,

Stoner

et al. 2010

Echocardiography

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Transesophageal Echocardiography for the Diagnosis of Pulmonary Vein Stenosis after Catheter Ablation of Atrial Fibrillation: A Systematic Review

Stavrakis¹,

Madden²,

Stoner

et al. 2010

Echocardiography

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“…19,21,22 After this iatrogenic complication, an interventional approach with angioplasty or stent implantation is preferred to achieve optimal drainage of the pulmonary veins with a reduction of symptoms. 14,19,[21][22][23][24][25] The stents used were bare-metal stents. Currently, no drug-eluting stents with adequate diameter are available.…”

Section: Discussionmentioning

confidence: 99%

Successful Angioplasty and Stent Treatment of Pulmonary Vein Stenosis After Single-lung Transplantation

Zimmermann

Reithmann

Strauß

et al. 2009

The Journal of Heart and Lung Transplantation

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“…Transesophageal echocardiography has been used in some centers to follow patients after pulmonary vein intervention. 33 Its usefulness may be limited in following smaller veins that continue to show abnormal flow patterns despite optimal intervention. In addition, TEE relies on increases in flow velocity as restenosis develops.…”

Section: -25mentioning

confidence: 99%

The State of the Art in Pulmonary Vein Stenosis - Diagnosis & Treatment

Prieto¹

2010

J.A.F.I.B

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Pulmonary vein stenosis is a rare but serious complication of pulmonary vein isolation to treat atrial fibrillation. Pulmonary vein angioplasty/stenting has emerged as the treatment of choice for significantly stenotic veins. Guidelines for post ablation evaluation of the pulmonary veins, including the timing and method of surveillance for possible stenosis, the criteria for intervention, the technical aspects of intervention, and finally the surveillance post intervention, are still being developed. The relatively high rate of restenosis after intervention in a subset of patients remains a great challenge. A better understanding of the pathophysiology underlying this syndrome is needed to appropriately answer many of the remaining questions. The goal of this manuscript is to describe what has been learned about this complication and its treatment from a relatively large experience in a single institution over the past decade, and provide a comprehensive review of the existing literature in order to shed as much light on the subject as is possible, while at the same time exposing the areas that need further study.www.jafib.com 27 Jan-Feb, 2010 | Vol 2 | Issue 4 decline. [9][10][11][12][13][14][15] Recognizing that there is no consensus at this time on routine screening for pulmonary vein stenosis after PVI, 16 we followa protocol at our institution to assure that the small number of patients who still develop significant pulmonary vein stenosis is not missed. Imaging is performed 3 months following PVI, and repeated 3 months later only if significant stenosis is detected at the time of the first scan.Detailed anatomy of the pulmonary veins is best defined by electrocardiographically (ECG)-gated contrast-enhanced multidetector computed tomogram (MDCT) [ Figure 1]. Frequently, images are acquired with retrospectively gated helical scanning. However, despite the use of dosemodulation, these protocols are associated with higher radiation exposure. Therefore, with recent advances in scanner technology, there is a trend to scanning with prospectively triggered protocols in patients with controlled heart rate. In those patients with fast and irregular heart rate, scanning with spiral non-gated imaging is a good alternative. Images are reconstructed with overlapping 1.00-to 1.25-mm slice thickness for analysis with multiplanar reconstructions, maxi mal intensity projections, and volume rendered imaging. Semi-automated analysis and display software supports the evaluation of the images.Cardiac MRI is an excellent alternative modality, and avoids exposure to ionizing radiation. It has been used in clinical care and clinical research, but is more expensive (at least in the United States) and time-consuming.17 Transesophageal echocardiography has been considered as a screening tool also to avoid radiation exposure, but it is not always possible to evaluate each pulmonary vein with 100% sensitivity when compared to MDCT, and it is not possible to evaluate the anatomy in detail if an interventional procedure is necess...

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Transesophageal echocardiography: A follow-up tool after catheter ablation of atrial fibrillation and interventional therapy of pulmonary vein stenosis and occlusion

Abstract: TEE can be used as a follow-up tool after interventional therapy in patients after catheter ablation and acquired PVS/PVO. Restenosis/in-stent restenosis can be identified by analyzing the vessel diameters and blood flow characteristics.

Cited by 21 publications

References 38 publications

Transesophageal Echocardiography for the Diagnosis of Pulmonary Vein Stenosis after Catheter Ablation of Atrial Fibrillation: A Systematic Review

Transesophageal Echocardiography for the Diagnosis of Pulmonary Vein Stenosis after Catheter Ablation of Atrial Fibrillation: A Systematic Review

Successful Angioplasty and Stent Treatment of Pulmonary Vein Stenosis After Single-lung Transplantation

The State of the Art in Pulmonary Vein Stenosis - Diagnosis & Treatment

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