Skip to main content
Top
Published in: Journal of Interventional Cardiac Electrophysiology 2/2018

01-03-2018

Impact of the pulmonary vein orifice area assessed using intracardiac echocardiography on the outcome of radiofrequency catheter ablation for atrial fibrillation

Authors: Takashi Nakashima, Masanori Kawasaki, Hiroyuki Toyoshi, Nobuhiro Takasugi, Tomoki Kubota, Hiromitsu Kanamori, Hiroaki Ushikoshi, Takuma Aoyama, Kazuhiko Nishigaki, Shinya Minatoguchi

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2018

Login to get access

Abstract

Purpose

The purposes of this study were to investigate pulmonary vein cross-sectional orifice area (PV-CSOA) using intracardiac echocardiography (ICE) and to determine its association with atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA).

Methods

We studied 77 patients undergoing initial RFCA for AF (55 paroxysmal and 22 persistent AF patients, mean age 61 ± 12 years, 59 men). The PV-CSOA was measured in each patient and expressed as an index divided by the body surface area—left superior (LSPV-CSOA), left inferior (LIPV-CSOA), right superior (RSPV-CSOA), and right inferior (RIPV-CSOA).

Results

After a mean follow-up of 21 ± 14 months, 61 patients maintained sinus rhythm (non-recurrence group) and AF recurred in 16 patients (recurrence group). The LSPV-CSOA index was significantly greater in the recurrence group compared with the non-recurrence group (146 ± 41 vs. 126 ± 30 mm2/m2, p = 0.04). A Cox regression multivariate analysis revealed that the LSPV-CSOA was the independent predictor of AF recurrence (HR 1.02, 95% CI 1.01–1.04, p = 0.01). The LSPV-CSOA cutoff value of 154 mm2/m2 predicts AF recurrence with 50% positive predictive value and 89% negative predictive value.

Conclusions

The present study suggests that ICE can be used as an alternative imaging tools for assessing the PV-CSOA during RFCA and that the LSPV-CSOA index was a useful independent predictor of AF recurrence after RFCA.
Literature
1.
go back to reference Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66.CrossRefPubMed Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66.CrossRefPubMed
2.
go back to reference Pappone C, Rosanio S, Augello G, Gallus G, Vicedomini G, Mazzone P, et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol. 2003;42:185–97.CrossRefPubMed Pappone C, Rosanio S, Augello G, Gallus G, Vicedomini G, Mazzone P, et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol. 2003;42:185–97.CrossRefPubMed
3.
go back to reference Tsao HM, Yu WC, Cheng HC, Wu MH, Tai CT, Lin WS, et al. Pulmonary vein dilation in patients with atrial fibrillation: detection by magnetic resonance imaging. J Cardiovasc Electrophysiol. 2001;12:809–13.CrossRefPubMed Tsao HM, Yu WC, Cheng HC, Wu MH, Tai CT, Lin WS, et al. Pulmonary vein dilation in patients with atrial fibrillation: detection by magnetic resonance imaging. J Cardiovasc Electrophysiol. 2001;12:809–13.CrossRefPubMed
4.
go back to reference Abecasis J, Dourado R, Ferreira A, Saraiva C, Cavaco D, Santos KR, et al. Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace. 2009;11:1289–94.CrossRefPubMed Abecasis J, Dourado R, Ferreira A, Saraiva C, Cavaco D, Santos KR, et al. Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace. 2009;11:1289–94.CrossRefPubMed
5.
go back to reference Scharf C, Sneider M, Case I, Chugh A, Lai SW, Pelosi F Jr, et al. Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography. J Cardiovasc Electrophysiol. 2003;14:150–5.CrossRefPubMed Scharf C, Sneider M, Case I, Chugh A, Lai SW, Pelosi F Jr, et al. Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography. J Cardiovasc Electrophysiol. 2003;14:150–5.CrossRefPubMed
6.
go back to reference Schwartzman D, Lacomis J, Wigginton WG. Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomography. J Am Coll Cardiol. 2003;41:1349–57.CrossRefPubMed Schwartzman D, Lacomis J, Wigginton WG. Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomography. J Am Coll Cardiol. 2003;41:1349–57.CrossRefPubMed
7.
go back to reference Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation. 2003;107:2004–10.CrossRefPubMed Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation. 2003;107:2004–10.CrossRefPubMed
8.
go back to reference Lickfett L, Kato R, Berger R, Halperin H, Calkins H. Magnetic resonance angiography and virtual endoscopic view of a left common pulmonary vein trunk. J Cardiovasc Electrophysiol. 2002;13:955.CrossRefPubMed Lickfett L, Kato R, Berger R, Halperin H, Calkins H. Magnetic resonance angiography and virtual endoscopic view of a left common pulmonary vein trunk. J Cardiovasc Electrophysiol. 2002;13:955.CrossRefPubMed
9.
go back to reference Wittkampf FH, Vonken EJ, Derksen R, Loh P, Velthuis B, Wever EF, et al. Pulmonary vein ostium geometry: analysis by magnetic resonance angiography. Circulation. 2003;107:21–3.CrossRefPubMed Wittkampf FH, Vonken EJ, Derksen R, Loh P, Velthuis B, Wever EF, et al. Pulmonary vein ostium geometry: analysis by magnetic resonance angiography. Circulation. 2003;107:21–3.CrossRefPubMed
10.
go back to reference Mansour M, Holmvang G, Sosnovik D, Migrino R, Abbara S, Ruskin J, et al. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15:387–93.CrossRefPubMed Mansour M, Holmvang G, Sosnovik D, Migrino R, Abbara S, Ruskin J, et al. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15:387–93.CrossRefPubMed
11.
go back to reference Lickfett L, Kato R, Tandri H, Jayam V, Vasamreddy CR, Dickfeld T, et al. Characterization of a new pulmonary vein variant using magnetic resonance angiography: incidence, imaging, and interventional implications of the “right top pulmonary vein”. J Cardiovasc Electrophysiol. 2004;15:538–43.CrossRefPubMed Lickfett L, Kato R, Tandri H, Jayam V, Vasamreddy CR, Dickfeld T, et al. Characterization of a new pulmonary vein variant using magnetic resonance angiography: incidence, imaging, and interventional implications of the “right top pulmonary vein”. J Cardiovasc Electrophysiol. 2004;15:538–43.CrossRefPubMed
12.
go back to reference Hauser TH, Essebag V, Baldessin F, McClennen S, Yeon SB, Manning WJ, et al. Prognostic value of pulmonary vein size in prediction of atrial fibrillation recurrence after pulmonary vein isolation: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2015;17:49.CrossRefPubMedPubMedCentral Hauser TH, Essebag V, Baldessin F, McClennen S, Yeon SB, Manning WJ, et al. Prognostic value of pulmonary vein size in prediction of atrial fibrillation recurrence after pulmonary vein isolation: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2015;17:49.CrossRefPubMedPubMedCentral
13.
go back to reference Morton JB, Sanders P, Byrne MJ, Power J, Mow C, Edwards GA, et al. Phased–array intracardiac echocardiography to guide radiofrequency ablation in the left atrium and at the pulmonary vein ostium. J Cardiovasc Electrophysiol. 2001;12:343–8.CrossRefPubMed Morton JB, Sanders P, Byrne MJ, Power J, Mow C, Edwards GA, et al. Phased–array intracardiac echocardiography to guide radiofrequency ablation in the left atrium and at the pulmonary vein ostium. J Cardiovasc Electrophysiol. 2001;12:343–8.CrossRefPubMed
14.
go back to reference Martin RE, Ellenbogen KA, Lau YR, Hall JA, Kay GN, Shepard RK, et al. Phased–array intracardiac echocardiography during pulmonary vein isolation and linear ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2002;13(9):873.CrossRefPubMed Martin RE, Ellenbogen KA, Lau YR, Hall JA, Kay GN, Shepard RK, et al. Phased–array intracardiac echocardiography during pulmonary vein isolation and linear ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2002;13(9):873.CrossRefPubMed
15.
go back to reference Mangrum JM, Mounsey JP, Kok LC, DiMarco JP, Haines DE. Intracardiac echocardiography-guided, anatomically based radiofrequency ablation of focal atrial fibrillation originating from pulmonary veins. J Am Coll Cardiol. 2002;39:1964–72.CrossRefPubMed Mangrum JM, Mounsey JP, Kok LC, DiMarco JP, Haines DE. Intracardiac echocardiography-guided, anatomically based radiofrequency ablation of focal atrial fibrillation originating from pulmonary veins. J Am Coll Cardiol. 2002;39:1964–72.CrossRefPubMed
16.
go back to reference Kinnaird TD, Uzun O, Munt BI, Thompson CR, Yeung-Lai-Wah JA. Transesophageal echocardiography to guide pulmonary vein mapping and ablation for atrial fibrillation. J Am Soc Echocardiogr. 2004;17:769–74.CrossRefPubMed Kinnaird TD, Uzun O, Munt BI, Thompson CR, Yeung-Lai-Wah JA. Transesophageal echocardiography to guide pulmonary vein mapping and ablation for atrial fibrillation. J Am Soc Echocardiogr. 2004;17:769–74.CrossRefPubMed
17.
go back to reference Yamamoto T, Yamada T, Yoshida Y, Inden Y, Tsuboi N, Suzuki H, et al. Comparison of the change in the dimension of the pulmonary vein ostia immediately after pulmonary vein isolation for atrial fibrillation-open irrigated-tip catheters versus non-irrigated conventional 4 mm-tip catheters. J Interv Card Electrophysiol. 2014;41:83–90.CrossRefPubMed Yamamoto T, Yamada T, Yoshida Y, Inden Y, Tsuboi N, Suzuki H, et al. Comparison of the change in the dimension of the pulmonary vein ostia immediately after pulmonary vein isolation for atrial fibrillation-open irrigated-tip catheters versus non-irrigated conventional 4 mm-tip catheters. J Interv Card Electrophysiol. 2014;41:83–90.CrossRefPubMed
18.
go back to reference Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace. 2007;9:335–79.CrossRefPubMed Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace. 2007;9:335–79.CrossRefPubMed
19.
go back to reference Cheema A, Dong J, Dalal D, Marine JE, Henrikson CA, Spragg D, et al. Circumferential ablation with pulmonary vein isolation in permanent atrial fibrillation. Am J Cardiol. 2007;99:1425–8.CrossRefPubMed Cheema A, Dong J, Dalal D, Marine JE, Henrikson CA, Spragg D, et al. Circumferential ablation with pulmonary vein isolation in permanent atrial fibrillation. Am J Cardiol. 2007;99:1425–8.CrossRefPubMed
20.
go back to reference Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefPubMed Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefPubMed
21.
go back to reference Vasamreddy CR, Jayam V, Lickfett L, Nasir K, Bradley DJ, Eldadah Z, et al. Technique and results of pulmonary vein angiography in patients undergoing catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15:21–6.CrossRefPubMed Vasamreddy CR, Jayam V, Lickfett L, Nasir K, Bradley DJ, Eldadah Z, et al. Technique and results of pulmonary vein angiography in patients undergoing catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15:21–6.CrossRefPubMed
22.
go back to reference Lin WS, Prakash VS, Tai CT, Hsieh MH, Tsai CF, Yu WC, et al. Pulmonary vein morphology in patients with paroxysmal atrial fibrillation initiated by ectopic beats originating from the pulmonary veins: implications for catheter ablation. Circulation. 2000;101:1274–81.CrossRefPubMed Lin WS, Prakash VS, Tai CT, Hsieh MH, Tsai CF, Yu WC, et al. Pulmonary vein morphology in patients with paroxysmal atrial fibrillation initiated by ectopic beats originating from the pulmonary veins: implications for catheter ablation. Circulation. 2000;101:1274–81.CrossRefPubMed
23.
go back to reference Napp AE, Enders J, Roehle R, G D, M R, E Z, et al. Analysis and prediction of claustrophobia during MR imaging with the claustrophobia questionnaire: an observational prospective 18-month single-center study of 6500 patients. Radiology. 2017;283:148–57.CrossRefPubMed Napp AE, Enders J, Roehle R, G D, M R, E Z, et al. Analysis and prediction of claustrophobia during MR imaging with the claustrophobia questionnaire: an observational prospective 18-month single-center study of 6500 patients. Radiology. 2017;283:148–57.CrossRefPubMed
24.
go back to reference Lin D, Callans DJ. Use of intracardiac echocardiography during atrial fibrillation ablation to avoid complications. Futur Cardiol. 2015;11:683–7.CrossRef Lin D, Callans DJ. Use of intracardiac echocardiography during atrial fibrillation ablation to avoid complications. Futur Cardiol. 2015;11:683–7.CrossRef
25.
go back to reference Hof I, Chilukuri K, Arbab-Zadeh A, Scherr D, Dalal D, Nazarian S, et al. Does left atrial volume and pulmonary venous anatomy predict the outcome of catheter ablation of atrial fibrillation? J Cardiovasc Electrophysiol. 2009;20:1005–10.CrossRefPubMed Hof I, Chilukuri K, Arbab-Zadeh A, Scherr D, Dalal D, Nazarian S, et al. Does left atrial volume and pulmonary venous anatomy predict the outcome of catheter ablation of atrial fibrillation? J Cardiovasc Electrophysiol. 2009;20:1005–10.CrossRefPubMed
26.
go back to reference den Uijl DW, Tops LF, Delgado V, Schuijf JD, Kroft LJ, de Roos A, et al. Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol. 2011;107:243–9.CrossRef den Uijl DW, Tops LF, Delgado V, Schuijf JD, Kroft LJ, de Roos A, et al. Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol. 2011;107:243–9.CrossRef
27.
go back to reference Merchant FM, Levy MR, Iravanian S, EC C, HM K, RL E, et al. Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies. J Interv Card Electrophysiol. 2016;46:89–96.CrossRefPubMed Merchant FM, Levy MR, Iravanian S, EC C, HM K, RL E, et al. Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies. J Interv Card Electrophysiol. 2016;46:89–96.CrossRefPubMed
28.
go back to reference Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005;111:127–35.CrossRefPubMed Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005;111:127–35.CrossRefPubMed
29.
go back to reference Hassink RJ, Aretz HT, Ruskin J, Keane D. Morphology of atrial myocardium in human pulmonary veins: a postmortem analysis in patients with and without atrial fibrillation. J Am Coll Cardiol. 2003;42:1108–14.CrossRefPubMed Hassink RJ, Aretz HT, Ruskin J, Keane D. Morphology of atrial myocardium in human pulmonary veins: a postmortem analysis in patients with and without atrial fibrillation. J Am Coll Cardiol. 2003;42:1108–14.CrossRefPubMed
30.
go back to reference Yamane T, Shah DC, Jaïs P, Hocini M, Peng JT, Deisenhofer I, et al. Dilatation as a marker of pulmonary veins initiating atrial fibrillation. J Interv Card Electrophysiol. 2002;6:245–9.CrossRefPubMed Yamane T, Shah DC, Jaïs P, Hocini M, Peng JT, Deisenhofer I, et al. Dilatation as a marker of pulmonary veins initiating atrial fibrillation. J Interv Card Electrophysiol. 2002;6:245–9.CrossRefPubMed
31.
go back to reference Thomas SP, Aggarwal G, Boyd AC, Jin Y, Ross DL. A comparison of open irrigated and non-irrigated tip catheter ablation for pulmonary vein isolation. Europace. 2004;6:330–5.CrossRefPubMed Thomas SP, Aggarwal G, Boyd AC, Jin Y, Ross DL. A comparison of open irrigated and non-irrigated tip catheter ablation for pulmonary vein isolation. Europace. 2004;6:330–5.CrossRefPubMed
Metadata
Title
Impact of the pulmonary vein orifice area assessed using intracardiac echocardiography on the outcome of radiofrequency catheter ablation for atrial fibrillation
Authors
Takashi Nakashima
Masanori Kawasaki
Hiroyuki Toyoshi
Nobuhiro Takasugi
Tomoki Kubota
Hiromitsu Kanamori
Hiroaki Ushikoshi
Takuma Aoyama
Kazuhiko Nishigaki
Shinya Minatoguchi
Publication date
01-03-2018
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 2/2018
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-018-0324-4

Other articles of this Issue 2/2018

Journal of Interventional Cardiac Electrophysiology 2/2018 Go to the issue