Role of Echocardiography in Pulmonary Vein Ablation for Atrial Fibrillation
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ECHOCARDIOGRAPHY (MH PICARD, SECTION EDITOR)
Role of Echocardiography in Pulmonary Vein Ablation for Atrial Fibrillation Andrew C. Y. To & Allan L. Klein
Published online: 14 September 2012 # Springer Science+Business Media, LLC 2012
Abstract Pulmonary vein ablation is increasingly used for patients with difficult to manage atrial fibrillation. Echocardiography plays a central role in the assessment of patients undergoing ablation therapy, not only in the pre-ablation patient selection and post-ablation assessment, but also in the peri-procedural guidance. Newer echocardiographic techniques including atrial mechanics measurements are also reviewed. Keywords Atrial fibrillation . Radiofrequency ablation . Echocardiography . Atrial mechanics . Pulmonary vein isolation . Pulmonary vein stenosis
from both transthoracic (TTE) and transesophageal (TEE) echocardiography is useful in the initial evaluation and patient selection, pre-procedural LA and LA appendage (LAA) thrombus screening, procedural imaging guidance for anatomic landmark visualization, and ablation complication assessment. Newer echocardiographic techniques including LA mechanics have been increasingly shown to be useful for post-ablation assessment and thromboembolism risk stratification.
Pre-Ablation Evaluation and Patient Selection Pre-Ablation General Evaluation
Introduction Atrial fibrillation (AF) is the commonest cardiac arrhythmia and leads to significant morbidity and mortality. Some patients with paroxysmal or persistent AF remain symptomatic despite best medical therapy, which often includes 1 or more Class I and III anti-arrhythmics [1]. Radiofrequency ablation for AF, or commonly called pulmonary vein isolation (PVI) is highly effective in restoring sinus rhythm and is associated with significantly improved symptoms, quality of life, exercise capacity, and left ventricular (LV) function [2, 3]. Echocardiography plays a central role in the assessment of AF patients undergoing PVI, in particular, in the assessment of left atrial (LA) structure and function. Information
A. C. Y. To Department of Cardiovascular Medicine, North Shore Hospital, Auckland, New Zealand A. L. Klein (*) Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA e-mail: [email protected]
Pre-ablation echocardiographic assessment of AF patients helps determine the overall management strategy appropriate for the individual patient. Clinical factors including the type and duration of AF, symptom severity, patient age and concurrent cardiovascular disease and other co-morbidities are carefully considered with the array of echocardiographic parameters. On TTE, possible underlying causes of AF are evaluated, including valvular heart disease, ischemic and non-ischemic cardiomyopathy, hypertensive and other infiltrative heart disease, as well as pericardial diseases. The effect of AF on the LV is also assessed, as untreated fast AF may cause tachycardia-induced cardiomyopathy. Information on LA size and LV systolic function is also
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