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

  • Takashi Nakashima
  • Masanori Kawasaki
  • Hiroyuki Toyoshi
  • Nobuhiro Takasugi
  • Tomoki Kubota
  • Hiromitsu Kanamori
  • Hiroaki Ushikoshi
  • Takuma Aoyama
  • Kazuhiko Nishigaki
  • Shinya Minatoguchi
Article
  • 33 Downloads

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.

Keywords

Atrial fibrillation Radiofrequency catheter ablation Intracardiac echocardiography Pulmonary vein isolation 

Notes

Author contributions

TN designed the study and wrote the manuscript. MK helped to analyze the dates and to draft the manuscript. HT, NT, and TK were the ablation operators and helped to write the manuscript. HK, HU, TA, and KN critically revised the article for important intellectual content. SM gave final approval of the article.

Compliance with ethical standards

This study was approved by the Institutional Review Board of Gifu University. Informed consent was obtained from all patients.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    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.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefPubMedGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    Lin D, Callans DJ. Use of intracardiac echocardiography during atrial fibrillation ablation to avoid complications. Futur Cardiol. 2015;11:683–7.CrossRefGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    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.CrossRefGoogle Scholar
  27. 27.
    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.CrossRefPubMedGoogle Scholar
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar
  31. 31.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Takashi Nakashima
    • 1
  • Masanori Kawasaki
    • 1
  • Hiroyuki Toyoshi
    • 2
  • Nobuhiro Takasugi
    • 1
  • Tomoki Kubota
    • 1
  • Hiromitsu Kanamori
    • 1
  • Hiroaki Ushikoshi
    • 1
  • Takuma Aoyama
    • 3
  • Kazuhiko Nishigaki
    • 1
  • Shinya Minatoguchi
    • 1
  1. 1.Department of CardiologyGifu University, Graduate School of MedicineGifuJapan
  2. 2.Department of CardiologyChuno Kousei HospitalSekiJapan
  3. 3.Department of CardiologyKizawa Memorial HospitalMinokamoJapan

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