Saad Eduardo B, Cole Christopher R, Marrouche Nassir F, Dresing Thomas J, Perez-Lugones Alejandro, Saliba Walid I, Schweikert Robert A, Klein Allan, Rodriguez Leonardo, Grimm Richard, Tchou Patrick, Natale Andrea
Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Ohio 44195, USA.
J Cardiovasc Electrophysiol. 2002 Oct;13(10):986-9. doi: 10.1046/j.1540-8167.2002.00986.x.
Measurements of pulmonary vein (PV) flow with intracardiac echocardiography (ICE) immediately before and after PV isolation may be a useful method for predicting which patients will develop chronic PV stenosis.
We assessed preablation and postablation flows in each of the four PVs using a phase-array ICE catheter in 95 patients (mean age 52 +/- 13) undergoing atrial fibrillation ablation. The ostium of each of the PVs was defined using angiography, electrical mapping, and ICE imaging. Ostial electrical isolation of all PVs was achieved using a 4-mm cooled-tip radiofrequency ablation catheter. Change in PV flow, when present, was examined as both an absolute value and as a percentage of the baseline flow. All patients underwent spiral computed tomography (CT) scans of the PVs 3 months after the procedure for detection of stenosis. The average preablation diastolic flows for the left superior, left inferior, right superior, and right inferior veins were 0.56, 0.54, 0.47, and 0.45 m/sec, respectively. These values increased to 0.74, 0.67, 0.58, and 0.59 m/sec postablation (P < 0.001). Of 380 PVs ablated, the CT scans revealed 2 (1%) with severe (>70%) stenosis, 13 (3%) with moderate (51%-70%) stenosis, and 62 (16%) with mild (< or = 50%) stenosis. The r value between flow and stenosis was only 0.09 (P = NS).
Acute changes in PV flow immediately after ostial PV isolation do not appear to be a strong predictor of chronic PV stenosis.
在肺静脉（PV）隔离前后立即用心腔内超声心动图（ICE）测量PV血流，可能是预测哪些患者会发生慢性PV狭窄的一种有用方法。
我们使用相控阵ICE导管，对95例（平均年龄52±13岁）接受房颤消融的患者的4条PV中的每条PV的消融前和消融后血流进行了评估。通过血管造影、电标测和ICE成像来确定每条PV的开口。使用4毫米冷盐水灌注射频消融导管实现所有PV开口处的电隔离。PV血流变化（如果存在）以绝对值和基线血流百分比两种方式进行检查。所有患者在手术后3个月接受PV的螺旋计算机断层扫描（CT）以检测狭窄情况。左上、左下、右上和右下肺静脉的平均消融前舒张期血流速度分别为0.56、0.54、0.47和0.45米/秒。消融后这些值分别增加到0.74、0.67、0.58和0.59米/秒（P<0.001）。在380条被消融的PV中，CT扫描显示2条（1%）有严重（>70%）狭窄，13条（3%）有中度（51%-70%）狭窄，62条（16%）有轻度（≤50%）狭窄。血流与狭窄之间的r值仅为0.09（P=无显著性差异）。
PV开口隔离后PV血流的急性变化似乎不是慢性PV狭窄的有力预测指标。
