Incidence of pulmonary vein stenosis 2 years after radiofrequency catheter ablation of refractory atrial fibrillation.
OBJECTIVE
Pulmonary vein ablation offers the potential to cure patients with atrial fibrillation. In this study, we investigated the incidence of pulmonary vein stenosis after radiofrequency catheter ablation of refractory atrial fibrillation by systematic long-term follow-up.


RESULTS
Forty-seven patients with refractory and highly symptomatic atrial fibrillation underwent radiofrequency catheter ablation of arrhythmogenic triggers inside the pulmonary veins and/or ostial pulmonary vein isolation with conventional mapping and ablation technology. These patients had follow-up examinations at 2 years with transoesophageal doppler-echo and/or angio magnetic resonance imaging for the evaluation of the pulmonary veins. Seventy-seven percent of the patients were free from atrial fibrillation, 51% were without antiarrhythmic drugs, and 26% were on previously ineffective antiarrhythmic drug therapy. However, 13 of the 47 patients showed significant pulmonary vein stenosis or occlusion. Only three of these 13 patients complained of dyspnoea. Distal ablations inside the pulmonary vein were associated with a 5.6-fold higher risk of stenosis than ostial ablations.


CONCLUSIONS
At 2-year follow-up, the risk of significant pulmonary vein stenosis/occlusion after radiofrequency catheter ablation of refractory atrial fibrillation with conventional mapping and ablation technology was 28%. Distal ablations inside smaller pulmonary veins should be avoided because of the higher risk of stenosis than ablation at the ostium.
Arentz
Thomas
T
Herz-Zentrum, Südring 15, 79188 Bad Krozingen, Germany. thomas.arentz@herzzentrum.de
Jander
Nikolaus
N
von Rosenthal
Jörg
J
Blum
Thomas
T
Fürmaier
Rudolf
R
Görnandt
Lothar
L
Josef Neumann
Franz
F
Kalusche
Dietrich
D
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D002908:Chronic Disease; D017548:Echocardiography, Transesophageal; D015716:Electrocardiography, Ambulatory; D004594:Electrophysiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011668:Pulmonary Veno-Occlusive Disease / Q000209:etiology*; D012008:Recurrence; D012307:Risk Factors