2.1 Echocardiographic Examination and Measurement of Atrial
Conduction Time
Echocardiographic examination was performed in all patients before
pulmonary vein RF ablation and 3 months after the ablation with GE
VividS6 system (GE Vingmed, Horten, Norway) using a probe of 2-4 MHz
frequency. Echocardiographic examination was performed with the patient
in the supine position and lying on the left side, using appropriate
echocardiographic windows with M mode, two-dimensional (2D), pulse wave
doppler, continuous wave doppler, color flow, and tissue doppler imaging
(TDI) methods.
2.2 M-mode echocardiography: Right ventricular end-systole and
diastole sizes and ejection fraction, end-diastole septum and posterior
wall thicknesses, and left atrial end-diastole dimensions were measured
with M-mode echocardiography.
2.3 2D echocardiography: Wall motion of both ventricles,
valvular structure and functions, and pericardial window were examined
with 2D echocardiography. Mitral flow parameters were measured at the
end of expiration by averaging three cardiac cycles.
2.4 Tissue Doppler Echocardiography: Simultaneous ECG
recordings were taken during tissue Doppler echocardiographic
examination. The time from the beginning of the P wave on the ECG to the
onset of the A’ wave in tissue Doppler (wave indicating atrial
contraction) was defined as the PA distance (atrial electromechanical
time) (Fig 1). Atrial electromechanical time was measured separately
from the lateral mitral annulus, septal mitral annulus, and lateral
tricuspid annulus; and defined as PA lateral, PA septum, and PA
tricuspid, respectively. The difference between PA lateral and PA
tricuspid (PA lateral – PA tricuspid) was defined as interatrial
conduction delay; and the difference between PA septum and PA tricuspid
(PA septum – PA tricuspid) as intraatrial conduction delay.
2.5 Transesophageal Echocardiography: All patients underwent
TEE with in 48 hours before the ablation. The echogenic mass in the LAA
that continued in more than one plane and distinguished from the
surrounding tissues was considered thrombus, and patients with
thrombus in the LAA were excluded.