Transesophageal detection of early systolic reverse pulmonary venous flow in atrial fibrillation

In patients with atrial fibrillation (AF) the pulmonary venous flow velocity pattern is characterized by the disappearance of atrial reverse flow, a decrease in systolic forward flow, and a greater diastolic than systolic forward flow. 1–2 Recently, an early reverse “flow” has also been described for the first time in humans, which appears systolic in timing. 3,4 However, no explanation was given of the possible mechanism involved or its influence on the pulmonary vein flow velocity pattern. This study identifies this early systolic reverse flow in both the left and right upper pulmonary veins in patients with AF, with the use of transesophageal echocardiography, and assesses the degree to which it affects pulmonary flow velocity pattern before and after cardioversion to sinus rhythm.