Transesophageal echocardiography: A screening method for pulmonary vein stenosis after catheter ablation of atrial fibrillation

Abstract

TEE identifies significant PV stenosis by assessment of flow characteristics and vessel diameter and can thereby be used as a follow-up tool after catheter ablation of atrial fibrillation.

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

“…The prevalence of PV stenosis ranged from 4% to 28% of patients (1–17% of PVs). Whereas most of the studies reported results at the PV level, only two studies also reported results at the patient level 17,24 . The exact prevalence of PV stenosis could not be calculated in two studies 16,23 .…”

“…Because the PV diameter before and after ablation was not available in most of the studies, we did not evaluate the diagnostic accuracy of TEE using a definition of PV stenosis based on PV ostial size. Furthermore, the lack of clear delineation of the left atrium‐PV junction by TEE may affect the measurements of PV ostial size 17 and make the calculated sensitivity and specificity less reliable. The available studies defined PV stenosis based on percent diameter loss in PV lumen compared to preablation or normal adjacent values.…”

“…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.…”

“…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. A formal meta-analysis was not performed because of the difficulty in interpreting pooled estimates across the different reference standards, diagnostic criteria, patient populations, and follow-up timing across the selected trials.…”

“…Transesophageal echocardiography (TEE) is an imaging modality used to diagnose PV stenosis that is widely available, has a favorable side effect profile and has been shown to have high sensitivity in preliminary studies. [14][15][16][17] There are no current guidelines that address the role of imaging modalities for the diagnosis of PV stenosis. 18,19 Although this issue is addressed by two recent consensus documents on AF ablation, each of them appears to endorse a somewhat different approach.…”