Three-dimensional transesophageal echocardiographic evaluation of pulmonary vein anatomy prior to cryoablation: validation with cardiac CT scan

• Published in: Cardiovascular ultrasound 2023-04, Vol.21 (1), p.6-6, Article 6
• Main Authors: Nagy, Laszlo Tibor, Jenei, Csaba, Papp, Timea Bianka, Urbancsek, Reka, Kolozsvari, Rudolf, Racz, Agnes, Raduly, Arnold Peter, Veisz, Richard, Csanadi, Zoltan
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Anatomy; Atria; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Bias; Blood clots; Computed tomography; Correlation coefficient; Correlation coefficients; Cryoablation; Cryosurgery - methods; Diameters; Echocardiography; Echocardiography, Transesophageal - methods; Evaluation; Feasibility; Female; Heart Atria - diagnostic imaging; Heart Atria - surgery; Humans; Male; Medical imaging; Middle Aged; Parameters; Polar environments; Pulmonary vein imaging; Pulmonary Veins - diagnostic imaging; Pulmonary Veins - surgery; Three-dimensional transesophageal echocardiography; Tomography; Tomography, X-Ray Computed; Treatment Outcome; Veins; Visualization
• ISSN: 1476-7120; 1476-7120
• DOI: 10.1186/s12947-023-00305-9

Anatomical characteristics of the left atrium and the pulmonary veins (PVs) may be relevant to the success rate of cryoballoon (CB)-ablation for atrial fibrillation (AF). Cardiac computed tomography (CCT) is considered as the gold standard for preablation imaging. Recently, three-dimensional transesophageal echocardiography (3DTOE) has been proposed for preprocedural assessment of cardiac structures relevant to CB-ablation. The accuracy of 3DTOE has not been validated by other imaging modalities. We prospectively evaluated the feasibility and the accuracy of 3DTOE imaging for the assessment of left atrial and PV structures prior to pulmonary vein isolation (PVI). In addition, CCT was used to validate the measurements obtained with 3DTOE. PV anatomy of 67 patients (59.7% men, mean age 58.5 ± 10.5 years) was assessed using both 3DTOE and CCT scan prior to PVI with the Arctic Front CB. The following parameters were measured bilaterally: PV ostium area (OA), the major and minor axis diameters of the ostium (a > b) and the width of the carina between the superior and the inferior PVs. In addition, the width of the left lateral ridge (LLR) between the left atrial appendage and the left superior PV. Evaluation of inter-technique agreement was based on linear regression with Pearson correlation coefficient (PCC) and Bland-Altman analysis of biases and limits of agreement. Moderate positive correlation (PCC 0.5-0.7) was demonstrated between the two imaging methods for the right superior PV's OA and both axis diameters, the width of the LLR and left superior PV (LSPV) minor axis diameter (b) with limits of agreement ˂50% and no significant biases. Low positive or negligible correlation (PCC