Author + information
- Francesco F. Faletra, MD⁎,⁎ (, )
- Gaetano Nucifora, MD⁎,
- François Regoli, MD, PhD⁎,
- Siew Yen Ho, MD, PhD†,
- Tiziano Moccetti, MD⁎ and
- Angelo Auricchio, MD, PhD⁎
- ↵⁎Address for correspondence:
Dr. Francesco F. Faletra, Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
real-time 3-dimensioanl transesophageal echocardiography (RT3DTEE) provides high quality images of the posterior structures of the heart (1) and has been used for guiding several catheter-based procedures (2).
The electrical isolation of pulmonary veins (PVs) has become a highly effective treatment option for symptomatic, drug-resistant atrial fibrillation (AF). RT3DTEE may potentially represent a novel monitoring modality for anatomy-driven PVs isolation. However, a standardized RT3DTEE protocol for imaging acquisition and processing of PVs is lacking. We describe a systematic step-by-step approach of acquisition modality of each PV by RT3DTEE, their normal appearance, comparison with equivalent anatomic specimens and examples of its use during catheter-based PV ablation. Images were acquired using a Philips IE 33 (Philips Medical System, Andover, Massachusetts) equipped with real-time transesophageal transducer and processed using Q lab software (Philips Medical System).
Theoretically, 3-dimensional imaging of the roof of the left atrium should be able to visualize all of the 4 PVs' ostia in a single image. However the right and left pairs of veins are widely separated and lie very close to the transducer. At this transducer distance, the pyramidal beam is too narrow to visualize the entire roof of the left atrium together with the PVs. Thus, the left and right PVs must be visualized separately. Images of left and right PVs in different views are presented in Figures 1, 2, 3, 4, 5, 6, and 7⇓⇓⇓⇓⇓; images of the lateral ridge are presented in Figures 8 and 9⇓⇓. Finally, an example of a case of isolation of left and right upper PVs is shown in Figures 10 and 11⇓⇓.
As for other interventional procedures, it is reasonable to forecast that this technique may become a useful complementary imaging modality in anatomy-driven radiofrequency PV ablation, hopefully resulting in significant reductions of procedural and fluoroscopy time.
Dr. Faletra has received speaker's fees from Philips. Dr. Regoli has received consultant fees from Mersk Sharp & Dohm (MSD) and Bristol-Myers Squibb. Dr. Auricchio has consulted for Sorin, Medtronic, Biotronik, EBR System, Merk, Biosense Webster, BDS Cordis, Philips, Impulse Dynamics, St. Jude, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation