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01-12-2006 | Cardiac

Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

Authors: Jaroslav Tintěra, Václav Porod, Robert Čihák, Hanka Mlčochová, Eva Rolencová, Pavel Fendrych, Josef Kautzner

Published in: European Radiology | Issue 12/2006

Abstract

One of the recognised complications of catheter ablation is pulmonary venous stenosis. The aim of this study was to compare two methods of evaluation of pulmonary venous diameter for follow-up assessment of the above complication: (1) a linear approach evaluating two main diameters of the vein, (2) semiautomatically measured cross-sectional area (CSA). The study population consists of 29 patients. All subjects underwent contrast-enhanced magnetic resonance angiography (CeMRA) of the pulmonary veins (PVs) before and after the ablation; 14 patients were also scanned 3 months later. PV diameter was evaluated from two-dimensional multiplanar reconstructions by measuring either the linear diameter or CSA. A comparison between pulmonary venous CSA and linear measurements revealed a systematic difference in absolute values. This difference was not significant when comparing the relative change CSA and quadratic approximation using linear extents (linear approach). However, a trend towards over-estimation of calibre reduction was documented for the linear approach. Using CSA assessment, significant PV stenosis was found in ten PVs (8%) shortly after ablation. Less significant PV stenosis, ranging from 20 to 50% was documented in other 18 PVs (15%). CeMRA with CSA assessment of the PVs is suitable method for evaluation of PV diameters.

Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, Clementy J (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666PubMedCrossRef

Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC, Hsu TL, Ding YA, Chang MS (1999) Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 100:1879–1886PubMed

Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, Vicedomini G, Salvati A, Dicandia C, Mazzone P, Santinelli V, Gulletta S, Chierchia S (2000) Circumferential readiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation. Circulation 102:2619–2628PubMed

Oral H, Scharf C, Chugh A, Hall B, Cheung P, Good E, Veerareddy S, Pelosi F Jr, Morady F (2003) Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 108:2355–2360PubMedCrossRef

Marrouche NF, Martin DO, Wazni O, Gillinov AM, Klein A, Bhargava M, Saad E, Bash D, Yamada H, Jaber W, Schweikert R, Tchou P, Abdul-Karim A, Saliba W, Natale A (2003) Phased-array intracardiac echocardiography monitoring during pulmonary vein isolation in patients with atrial fibrillation: impact on outcome and complications. Circulation 107:2710–2716PubMedCrossRef

Ghaye B, Szapiro D, Dacher JN, Rodriguez LM, Timmermans C, Devillers D, Dondelinger RF (2003) Percutaneous ablation for atrial fibrillation: the role of cross-sectional imaging. Radiographics 23:S19–S33PubMed

Cirillo S, Bonamini R, Gaita F, Tosetti I, De Giuseppe M, Longo M, Bianchi F, Vivalda L, Regge D (2004) Magnetic resonance angiography virtual endoscopy in the assessment of pulmonary veins before radiofrequency ablation procedures for atrial fibrillation. Eur Radiol 14:2053–2060PubMedCrossRef

Tsao HM, Chen SA (2002) Evaluation of pulmonary vein stenosis after catheter ablation of atrial fibrillation. Card Electrophysiol Rev 6:397–400PubMedCrossRef

Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G, Angkeow P, LaCorte J, Bluemke D, Berger R, Halperin HR, Calkins H (2003) Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation. Circulation 107:2004–2010PubMedCrossRef

10.

Dill T, Neumann T, Ekinci O, Breidenbach C, John A, Erdogan A, Bachmann G, Hamm CW, Pitschner H (2003) Pulmonary vein diameter reduction after radiofrequency catheter ablation for paroxysmal atrial fibrillation evaluated by contrast-enhanced three-dimensional magnetic resonance imaging. Circulation 107:845–850PubMedCrossRef

11.

Saad EB, Marrouche NF, Saad CP, Ha E, Bash D, White RD, Rhodes J, Prieto L, Martin DO, Saliba WI, Schweikert RA, Natale A (2003) Pulmonary vein stenosis after catheter ablation of atrial fibrillation: emergence of a new clinical syndrome. Ann Intern Med 138:634–638PubMed

12.

Saad EB, Rossillo A, Saad CP, Martin DO, Bhargava M, Erciyes D, Bash D, Williams-Andrews M, Beheiry S, Marrouche NF, Adams J, Pisano E, Fanelli R, Potenza D, Raviele A, Bonso A, Themistoclakis S, Brachmann J, Saliba WI, Schweikert RA, Natale A (2003) Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation 108:3102–3107PubMedCrossRef

13.

Arentz T, Jander N, von Rosenthal J, Blum T, Furmaier R, Gornandt L, Neumann J, Kalusche D (2003) Incidence of pulmonary vein stenosis 2 years after radiofrequency catheter ablation of refractory atrial fibrilation. Eur Heart J 24:963–969PubMedCrossRef

14.

Purerfellner H, Aichinger J, Martinek M, Nesser HJ, Cihal R, Gschwendtner M, Dierneder J (2004) Incidence, management, and outcome in significant pulmonary vein stenosis complicating ablation for atrial fibrillation. Am J Cardiol 93:1428–1431PubMedCrossRef

15.

Kluge A, Dill T, Ekinci O, Hansel J, Hamm CW, Pitschner H, Bachmann G (2004) Decreased pulmonary perfusion in pulmonary vein stenosis after radiofrequency ablation. Chest 126:428–437PubMedCrossRef

16.

Packer DL, Keelan P, Munger TM, Breen JF, Asirvatham S, Peterson LA, Monahan KH, Hauser MF, Chandrasekaran K, Sinak LJ, Holmes DR Jr (2005) Clinical presentation, investigation, and management of pulmonary vein stenosis complicating ablation for atrial fibrillation. Circulation 111:546–554PubMedCrossRef

17.

Wielopolski P, Haacke EM, Adler LP (1993) Evaluation of the pulmonary vasculature with three-dimensional magnetic resonance technique. MAGMA 1:21–34

18.

Maksimovic R, Scholten MF, Cademartiri F, Jordaens LJ, Pattynama PM (2005) Sixteen multidetector row computed tomography of pulmonary veins: 3-months’ follow-up after treatment of paroxysmal atrial fibrillation with cryothermal ablation. Eur Radiol 15:1122–1127PubMedCrossRef

19.

Schoenberg SO, Bock M, Floemer F, Grau A, Williams DM, Laub G, Knopp MV (1999) High-resolution pulmonary arterio- and venography using multiple-bolus multiphase 3D-Gd-MRA. J Magn Reson Imaging 10:339–346PubMedCrossRef

20.

Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Packer D, Skanes A (2005) Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 111:1100–1105PubMedCrossRef

21.

Tamborero D, Mont L, Nava S, de Caralt TM, Molina I, Scalise A, Perea RJ, Bartholomay E, Berruezo A, Matiello M, Brugada J (2005) Incidence of pulmonary vein stenosis in patients submitted to atrial fibrillation ablation: a comparison of the selective segmental ostial ablation vs the circumferential pulmonary veins ablation. J Interv Card Electrophysiol 14:21–25PubMedCrossRef

22.

Saad EB, Cole CR, Marrouche NF, Dresing TJ, Perez-Lugones A, Saliba WI, Schweikert RA, Klein A, Rodriguez L, Grimm R, Tchou P, Natale A (2002) Use of intracardiac echocardiography for prediction of chronic pulmonary vein stenosis after ablation of atrial fibrillation. J Cardiovasc Electrophysiol 13:986–989PubMedCrossRef

23.

Ren JF, Marchlinski FE, Callans DJ, Zado ES (2002) Intracardiac Doppler echocardiographic quantification of pulmonary vein flow velocity: an effective technique for monitoring pulmonary vein ostia narrowing during focal atrial fibrillation ablation. J Cardiovasc Electrophysiol 13:1076–1081PubMedCrossRef

24.

Wittkampf FH, Vonken EJ, Derksen R, Loh P, Velthuis B, Wever EF, Boersma LV, Rensing BJ, Cramer MJ (2003) Pulmonary vein ostium geometry: analysis by magnetic resonance angiography. Circulation 107:21–23PubMedCrossRef

25.

Berkowitsch A, Neumann T, Ekinci O, Greiss H, Dill T, Kurzidim K, Kuniss M, Schneider HJ, Pitschner HF (2005) A decrease in pulmonary vein diameter after radiofrequency ablation predicts the development of severe stenosis. Pacing Clin Electrophysiol 28(Suppl) 1:S83–S85PubMedCrossRef

26.

Lickfett L, Dickfeld T, Kato R, Tandri H, Vasamreddy CR, Berger R, Bluemke D, Luderitz B, Halperin H, Calkins H (2005) Changes of pulmonary vein orifice size and location throughout the cardiac cycle: dynamic analysis using magnetic resonance cine imaging. J Cardiovasc Electrophysiol 16:582–588PubMedCrossRef

Title: Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements
Authors: Jaroslav Tintěra
Václav Porod
Robert Čihák
Hanka Mlčochová
Eva Rolencová
Pavel Fendrych
Josef Kautzner
Publication date: 01-12-2006
Publisher: Springer-Verlag
Published in: European Radiology / Issue 12/2006
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-006-0358-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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