Pulmonary Vein Morphology Before and After Segmental Isolation in Patients with Atrial Fibrillation

Marehiko Ueda; Hiroshi Tada; Kenji Kurosaki; Kazuhiro Itoi; Keiko Koyama; Shigeto Naito; Sachiko Ito; Issei Komuro; Shigeru Oshima; Koichi Taniguchi

Disclosures

Pacing Clin Electrophysiol. 2005;28(9):944-953. 

In This Article

Abstract and Introduction

Background: The morphology of the pulmonary veins (PVs) before and after segmental isolation of the PVs has not been sufficiently characterized.
Methods and Results: Multi-slice computed tomography was performed before and 3 ± 1 months after ablation in 30 patients with atrial fibrillation who underwent PV isolation. Before ablation, PV narrowing (≥25% luminal reduction) was found in nine (8%) PVs. After ablation, de novo PV narrowing was found in 24 PVs (26%) and was detected only in the supero-inferior direction in 14 PVs (58%). The diameter reduction inside the PVs after ablation was greater in the supero-inferior direction (14 ± 12%) than in the antero-posterior direction (9 ± 13%; P < 0.0001). In the ablated PVs, the PV trunk was shorter than before ablation (P < 0.0001). The reduction in the diameters of both the PV ostium and the ablation site in the ablated PVs, as well as the diameter of the PV ostium in the nonablated PVs, correlated with the decrease in the left atrial diameter. Shortening of the PV trunk correlated with the severity of PV narrowing, but it was not related to the percent diameter reduction of the left atrium. PV narrowing before or after ablation did not result in any clinical consequences.
Conclusions: PV narrowing is present in about 10% of PVs before ablation. Asymmetric luminal reduction and longitudinal shrinkage of the PV trunk occur after ablation. Reverse remodeling of the PV and contraction of the PV wall may contribute to the reduction in the PV diameter. PV morphology should be assessed with multi-directional views to avoid missing heterogeneous legions.

Segmental ostial ablation to isolate the pulmonary veins (PV isolation) has been demonstrated to be effective in curing atrial fibrillation (AF).[1,2] However, radiofrequency (RF) energy delivery in the PVs is associated with the development of PV stenosis.[3,4,5,6] The morphology of the PVs and anatomical alternation after RF ablation have been investigated using magnetic resonance imaging and computed tomography (CT).[4,5,6,7] However, a detailed and quantitative analysis of the PV morphology after ablation using multi-directional views has not been performed. Furthermore, the presence and incidence of PV narrowing before ablation or longitudinal PV shrinkage after ablation has not yet been examined. It is well known that AF can induce structural remodeling of the atria and cause atrial enlargement, which may be reversible if AF is converted and sinus rhythm maintained (reverse remodeling).[4,5] However, reverse remodeling of the PVs after ablation has not been sufficiently demonstated. The Purpose of this study was to clarify those points.

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