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 < 0.5) was found for both inferior PV parameters. Detailed assessment of the right superior PV parameters, LLR and LSPV b is feasible with 3DTOE prior to AF ablation. This 3DTOE measurements demonstrated a clinically acceptable inter-technique agreement with those obtained with CCT. Novel 3DTOE method for the assessment of PV parameters relevant to CB ablation. The first direct comparison of pre-ablation measurements with 3DTOE and CCT imaging. 3DTOE measurements of RSPV, LLR and the LSPV’s minor axis diameter were validated by CCT.

中文翻译：

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冷冻消融前肺静脉解剖的三维经食管超声心动图评估：心脏 CT 扫描验证

左心房和肺静脉 (PV) 的解剖学特征可能与冷冻球囊 (CB) 消融治疗心房颤动 (AF) 的成功率有关。心脏计算机断层扫描 (CCT) 被认为是消融前成像的金标准。最近，三维经食管超声心动图 (3DTOE) 已被提议用于术前评估与 CB 消融相关的心脏结构。3DTOE 的准确性尚未得到其他成像方式的验证。我们前瞻性地评估了 3DTOE 成像在肺静脉隔离 (PVI) 之前评估左心房和 PV 结构的可行性和准确性。此外，CCT 用于验证使用 3DTOE 获得的测量值。67 名患者的 PV 解剖结构（59.7% 为男性，平均年龄 58.5 ± 10. 5 年）在使用 Arctic Front CB 进行 PVI 之前使用 3DTOE 和 CCT 扫描进行评估。双侧测量以下参数：PV 开口面积 (OA)、开口的长轴和短轴直径 (a > b) 以及上下 PV 之间的隆突宽度。此外，左心耳和左上 PV 之间的左侧脊 (LLR) 的宽度。技术间一致性的评估基于具有 Pearson 相关系数 (PCC) 的线性回归和偏差和一致性限制的 Bland-Altman 分析。在右上 PV 的 OA 和两个轴直径的两种成像方法之间证明了中度正相关 (PCC 0.5–0.7)，LLR 的宽度和左上 PV (LSPV) 短轴直径 (b) 的协议限制为 ˂50%，并且没有显着偏差。对于两个较差的 PV 参数，发现低正相关或可忽略不计的相关性 (PCC < 0.5)。在 AF 消融之前，使用 3DTOE 可以对正确的高级 PV 参数、LLR 和 LSPV b 进行详细评估。该 3DTOE 测量结果表明，与通过 CCT 获得的结果在临床上可接受的技术间一致性。用于评估与 CB 消融相关的 PV 参数的新型 3DTOE 方法。烧蚀前测量与 3DTOE 和 CCT 成像的首次直接比较。RSPV、LLR 和 LSPV 的短轴直径的 3DTOE 测量值通过 CCT 验证。在 AF 消融之前，使用 3DTOE 可以对正确的高级 PV 参数、LLR 和 LSPV b 进行详细评估。该 3DTOE 测量结果表明，与通过 CCT 获得的结果在临床上可接受的技术间一致性。用于评估与 CB 消融相关的 PV 参数的新型 3DTOE 方法。烧蚀前测量与 3DTOE 和 CCT 成像的首次直接比较。RSPV、LLR 和 LSPV 的短轴直径的 3DTOE 测量值通过 CCT 验证。在 AF 消融之前，使用 3DTOE 可以对正确的高级 PV 参数、LLR 和 LSPV b 进行详细评估。该 3DTOE 测量结果表明，与通过 CCT 获得的结果在临床上可接受的技术间一致性。用于评估与 CB 消融相关的 PV 参数的新型 3DTOE 方法。烧蚀前测量与 3DTOE 和 CCT 成像的首次直接比较。RSPV、LLR 和 LSPV 的短轴直径的 3DTOE 测量值通过 CCT 验证。