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Journal of Thoracic Imaging May 2020The purpose of this study was to define the full spectrum of pulmonary computed tomography (CT) changes characteristic of postablation pulmonary vein stenosis (PVS).
PURPOSE
The purpose of this study was to define the full spectrum of pulmonary computed tomography (CT) changes characteristic of postablation pulmonary vein stenosis (PVS).
MATERIALS AND METHODS
We retrospectively reviewed our pulmonary vein isolation database. PVS was graded as follows: grade 1:<50%, grade 2: 50% to 75%, grade 3: 76% to 99%, and grade 4: total occlusion. CT parenchymal and vascular changes were detected and correlated with clinical course and nuclear scans.
RESULTS
Of 486 patients who underwent pulmonary vein isolation, 56 patients (11%) were symptomatic, prompting referral to CT evaluation. Grades 1, 2, 3, and 4 PVS were documented in 42, 1, 2, and 11 patients, respectively. Apart from PVS, abnormal CT findings were present only in patients with PVS grades 2 to 4. Pulmonary parenchymal changes (consolidation, "ground glass" opacities, interlobular septal thickening, and volume loss) were found in PVS grades 2 to 4. Pulmonary vascular changes (oligemia, "sluggish flow," and collateral mediastinal vessels) were shown in patients with grades 3 to 4 PVS. Concomitant nuclear scans documented reduced lung perfusion. All findings were located to the lobe drained by the affected vein. Complete resolution of pulmonary findings on follow-up CT scans was demonstrated in 20% of patients. Eleven stents were inserted in 7 patients with PVS grades 2 to 4, none of which demonstrated radiologic or clinical resolution.
CONCLUSIONS
A typical CT complex of both parenchymal and vascular findings in the affected lobe is diagnostic of postablation PVS. Lack of clinical and radiologic resolution in most patients, even after stent insertion, further highlights the importance of early recognition of this underdiagnosed condition.
Topics: Catheter Ablation; Humans; Pulmonary Veins; Retrospective Studies; Stenosis, Pulmonary Vein; Tomography, X-Ray Computed
PubMed: 31385876
DOI: 10.1097/RTI.0000000000000435 -
Europace : European Pacing,... Dec 2023Pulsed field ablation (PFA) is emerging as a non-thermal, tissue-specific technique for pulmonary vein isolation (PVI) in atrial fibrillation therapy. This pre-clinical...
AIMS
Pulsed field ablation (PFA) is emerging as a non-thermal, tissue-specific technique for pulmonary vein isolation (PVI) in atrial fibrillation therapy. This pre-clinical study aims to investigate the feasibility and safety of PVI using a novel PFA system including a nanosecond-scale PFA generator, a novel lotos PFA catheter, and a customized 12 Fr steerable sheath.
METHODS AND RESULTS
A total of 11 Yorkshire swine were included in this study, with 4 in the acute cohort and 7 in the chronic cohort. Under general anaesthesia, transseptal puncture and pulmonary vein (PV) angiography was initially performed. The PFA catheter was navigated to position at the right and left PV antrum after the electroanatomic reconstruction of the left atrium. Biphasic PFA applications were performed on PVs in both the spindle-shaped and the lotos-shaped poses. Pulmonary vein isolation and PFA-associated safety were assessed 30 min after ablation in both cohorts and 30 days later in the chronic cohort. Detailed necropsy and histopathology were performed. Additional intracardiac echocardiography and coronary angiogram were evaluated for safety. All target PVs (n = 20) were successfully isolated on the first attempt. No spasm of coronary artery or microbubble was seen during the procedure. Eleven of 12 PVs (91.6%) remained in isolation at the 30-day invasive study. No evidence of PV stenosis was observed in any targets. However, transient diaphragm capture occurred in 17.6%. Histopathological examinations showed no evidence of collateral injury.
CONCLUSION
This study provides scientific evidence demonstrating the safety and efficacy of the novel PFA catheter and system for single-shot PVI, which shows great potential.
Topics: Humans; Swine; Animals; Pulmonary Veins; Feasibility Studies; Atrial Fibrillation; Catheter Ablation; Catheters; Treatment Outcome
PubMed: 38109928
DOI: 10.1093/europace/euad362 -
Expert Review of Medical Devices May 2022Catheter ablation has been demonstrated to be a safe and an effective treatment for drug resistant atrial fibrillation (AF); electrical isolation of pulmonary veins... (Review)
Review
INTRODUCTION
Catheter ablation has been demonstrated to be a safe and an effective treatment for drug resistant atrial fibrillation (AF); electrical isolation of pulmonary veins (PVI) is the main strategy in paroxysmal AF, since pulmonary vein triggers have a pivotal role in its pathogenesis; non-paroxysmal AF is a complex arrhythmia that results from the interplay of a substrate, namely AF-induced electrical and structural atrial remodeling, and a trigger that can be often found outside pulmonary veins, namely non-pulmonary veins triggers.
AREAS COVERED
The aim of this review is to provide a state-of-the-art overview of non-pulmonary veins triggers with special focus on cryoballoon (CB) catheter ablation.
EXPERT OPINION
Besides PVI, CB catheter ablation of non-pulmonary veins triggers is a novel and promising strategy for non-paroxysmal AF.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Treatment Outcome
PubMed: 35786107
DOI: 10.1080/17434440.2022.2096437 -
Cardiac Electrophysiology Clinics Jun 2020When patients have symptomatic recurrent atrial tachyarrhythmias after 2 months following pulmonary vein antral isolation, a repeat ablation should be considered.... (Review)
Review
When patients have symptomatic recurrent atrial tachyarrhythmias after 2 months following pulmonary vein antral isolation, a repeat ablation should be considered. Patients might present with isolated pulmonary veins posterior wall. In these patients, posterior wall isolation is extended, and non-pulmonary vein triggers are actively sought and ablated. Moreover, in those with non-paroxysmal atrial fibrillation or a known higher prevalence of non-pulmonary vein triggers, empirical isolation of the superior vena cava, coronary sinus, and/or left atrial appendage might be performed. In this review, we will focus on ablation of non-pulmonary vein triggers, summarizing our current approach for their mapping and ablation.
Topics: Atrial Appendage; Atrial Fibrillation; Catheter Ablation; Coronary Sinus; Humans; Pulmonary Veins; Recurrence
PubMed: 32451105
DOI: 10.1016/j.ccep.2020.02.001 -
Journal of Thoracic Imaging Sep 2021In patients with atrial fibrillation refractory to drug therapy and cardioversion, pulmonary vein ablation is an alternative treatment that eradicates arrhythmogenic... (Review)
Review
In patients with atrial fibrillation refractory to drug therapy and cardioversion, pulmonary vein ablation is an alternative treatment that eradicates arrhythmogenic activity originating in the muscles of the pulmonary veins. While this procedure has a low incidence of significant complications, iatrogenic injuries are possible. Through multimodality pictorial examples utilizing computed tomography, nuclear medicine, fluoroscopy, and chest radiographs, the complications associated with pulmonary vein ablation will be reviewed. Examples of pulmonary vein stenosis, right phrenic nerve injury with associated diaphragmatic paralysis, atrioesophageal fistula, and pericardioesophageal fistula will be illustrated.
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Peripheral Nerve Injuries; Phrenic Nerve; Pulmonary Veins; Treatment Outcome
PubMed: 32960836
DOI: 10.1097/RTI.0000000000000561 -
JACC. Clinical Electrophysiology Oct 2020
Topics: Athletes; Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins
PubMed: 33092754
DOI: 10.1016/j.jacep.2020.06.013 -
Pediatric Cardiology Oct 2023The fetal pulmonary circulation represents less than 25% of the fetal cardiac output. In comparison with the pulmonary arteries, studies on pulmonary veins are few and... (Review)
Review
The fetal pulmonary circulation represents less than 25% of the fetal cardiac output. In comparison with the pulmonary arteries, studies on pulmonary veins are few and limited, and many questions remain to be answered. The literature reports that pulmonary veins play an important role in regulating vascular flow, forming an active segment of the pulmonary circulation. The development of more sophisticated ultrasonography technology has allowed the investigation of the extraparenchymal pulmonary veins and their waveform. The recognition of the pulmonary vein anatomy in echocardiography is important for the diagnosis of anomalous pulmonary venous connections, with a significant impact on prognosis. On the other hand, the identification of the normal pulmonary vein waveform seems to be a reliable way to study left heart function, with potential applicability in fetal and maternal pathology. Thus, the goal of this narrative review was to provide a clinically oriented perspective of the available literature on this topic.
Topics: Pregnancy; Female; Humans; Pulmonary Veins; Ultrasonography, Prenatal; Fetus; Echocardiography; Ultrasonography, Doppler
PubMed: 37505268
DOI: 10.1007/s00246-023-03244-4 -
Journal of Cardiovascular... Aug 2020Pulmonary vein isolation (PVI) is a well-established treatment for atrial fibrillation (AF); however, studies report suboptimal outcomes in persistent AF. Adjuvant... (Review)
Review
Pulmonary vein isolation (PVI) is a well-established treatment for atrial fibrillation (AF); however, studies report suboptimal outcomes in persistent AF. Adjuvant ablation targeting the substrate outside the pulmonary veins has been proposed to improve the success rates of the procedure. In this review, we summarize the current evidence regarding additional ablation over PVI in persistent AF. We describe the different approaches for adjuvant ablation, outcomes, and future perspectives.
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 32022320
DOI: 10.1111/jce.14381 -
Esophagus : Official Journal of the... Oct 2023This study aimed to investigate the relationship between postoperative atrial fibrillation (POAF) after esophagectomy and pre-existing cardiac substrate.
BACKGROUND
This study aimed to investigate the relationship between postoperative atrial fibrillation (POAF) after esophagectomy and pre-existing cardiac substrate.
METHODS
We retrospectively analyzed 212 consecutive patients from between July 2010 and December 2022 who were scheduled to undergo esophagectomy for esophageal cancer without previous history of atrial fibrillation. All the patients underwent both echocardiography and contrast-enhanced multi-detector computed tomography (MDCT).
RESULTS
POAF occurred in 49 patients (23.1%). Multivariable logistic analysis demonstrated that independent predictors for POAF were age [OR; 1.06 (1.01-1.10), P < 0.01), three-field lymph node dissection [OR; 2.55 (1.25-5.23), P < 0.01), left atrial dilatation (> 35 mm) assessment by echocardiography [OR; 3.05 (1.49-6.25), P < 0.01) and common left pulmonary vein [OR; 3.03 (1.44-6.39), P < 0.01). The correlation coefficient was high for left atrial dimensions assessed by echocardiography and MDCT (r = 0.91, P < 0.01). Combination of left atrial dilatation by echocardiography and common left pulmonary vein had high odds ratio [OR; 8.10 (2.62-25.96), P < 0.01). Instead of echocardiographic assessment, combination of left atrial enlargement (> 35 mm) assessed by MDCT and common left pulmonary vein also showed high odds ratio for POAF [OR; 11.23 [2.19-57.63], P < 0.01).
CONCLUSION
Incidence of POAF after esophagectomy was related to both left atrial enlargement and common left pulmonary vein assessed by preoperative MDCT. Additional analysis of atrial size and pulmonary vein variation would facilitate preoperative assessment of the risk of POAF, but future studies must ascertain therapeutic strategy.
Topics: Humans; Atrial Fibrillation; Pulmonary Veins; Retrospective Studies; Esophagectomy; Prospective Studies; Treatment Outcome; Esophageal Neoplasms
PubMed: 37347342
DOI: 10.1007/s10388-023-01018-8 -
General Thoracic and Cardiovascular... Dec 2021Acquired pulmonary vein (PV) stenosis (PVS) is a complication following cardiac catheter intervention. However, very few cases of PVS after surgical ablation have been...
Acquired pulmonary vein (PV) stenosis (PVS) is a complication following cardiac catheter intervention. However, very few cases of PVS after surgical ablation have been reported. We herein report a case of stenosis and occlusion at the left atrium to each pulmonary vein after surgical ablation. A 73-year-old woman who had received aortic valve replacement and pulmonary vein isolation 10 months earlier was diagnosed with congestive heart failure accompanied by pulmonary hypertension. Contrast-enhanced computed tomography revealed stenosis and complete occlusion of the left atrium to all four pulmonary veins. Surgical repair was performed via pericardial patch reconstruction of the left atrium to each PV. Treating multiple PV lesions with involvement of the left atrium wall requires tailored methods. However, there have been few reports concerning such methods of reconstruction. We herein report a method of reconstructing the left atrium and pulmonary veins at the same time.
Topics: Aged; Atrial Fibrillation; Catheter Ablation; Female; Heart Atria; Humans; Pulmonary Veins; Stenosis, Pulmonary Vein; Treatment Outcome
PubMed: 34514539
DOI: 10.1007/s11748-021-01700-7