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European Heart Journal 1999 20(5):375-385; doi:10.1053/euhj.1998.1310
Copyright © 1999 by the European Society of Cardiology.
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Pulmonary vein flow analysis by transoesophageal echocardiography in patients with chronic atrial fibrillation; 1 year follow-up after cardioversion

I.A Paraskevaidisf1, G.N Theodorakis, D.G Katritsis, D.P Tsiapras, E.G Livanis and D.T Kremastinos

2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece

revised September 7, 1998; accepted September 9, 1998

Abstract

Aims

Left and right upper pulmonary vein flow can be adequately recorded by transoesophageal Doppler echocardiography. The aim of this study was to investigate whether analysis of the pulmonary venous flow velocity pattern can predict the long-term maintenance of sinus rhythm after successful cardioversion of chronic atrial fibrillation.

Methods and Results

Thirty-six consecutive patients, aged 53±9 years, with chronic atrial fibrillation of 5·33±2 months duration, were subjected to transoesophageal Doppler echocardiography to record left and right upper pulmonary venous flow, 24h and 3 months following successful cardioversion. One year following cardioversion, 12 patients (33·3%) were in sinus rhythm (sinus rhythm group) while the remaining 24 patients were in atrial fibrillation (atrial fibrillation group). At 24h following cardioversion, biphasic systolic forward flow in the left and/or right upper pulmonary venous flow velocity was detected in 10 patients of the sinus rhythm group and in four patients of the atrial fibrillation group (P<0·001). The systolic fraction was significantly higher in the sinus rhythm group, 0·48±0·04 and 0·39±0·06,P<0·001 for the left upper pulmonary venous flow, and 0·52±0·05 and 0·41±0·04,P<0·001 for the right upper pulmonary venous flow, respectively. In patients who displayed a biphasic systolic forward flow and in whom the right upper pulmonary venous flow systolic fraction was higher than 0·50 at 24h post-cardioversion, the probability of maintenance of sinus rhythm at 1 year exceeded 95%.

Conclusion

The detection of a biphasic systolic forward flow in the pulmonary venous flow velocity, and of a right upper pulmonary vein systolic fraction higher than 0·50 as early as 24h following cardioversion of chronic atrial fibrillation, identifies patients who will remain in sinus rhythm 1 year after cardioversion.

Key Words: Atrial fibrillation • pulmonary vein flow • trans-oesophageal echocardiography

f1 Correspondence: Ioannis A. Paraskevaidis, MD, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 17674 Athens, Greece.

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