Transcatheter angioplasty for acquired pulmonary vein stenosis after radiofrequency ablation.
BACKGROUND
Pulmonary vein stenosis has recently been recognized as a complication of radiofrequency ablation for atrial fibrillation. This study evaluates the presentation of affected patients and the role of transcatheter therapy for this patient population.


RESULTS
This study used a retrospective review of data from 19 patients (age, 51+/-13 years) with pulmonary vein stenosis who underwent catheterization and angiography between December 2000 and December 2002. Quantitative perfusion and spiral CT scans were performed for initial diagnosis and follow-up. The median duration between radiofrequency ablation and the reported onset of respiratory symptoms for 18 of 19 patients was 7.5 weeks (0.1 to 48). After the onset of symptoms, all but two patients were initially misdiagnosed with a symptoms-to-diagnosis duration of 16 weeks (2-59). At initial catheterization, 17 of 19 patients had angioplasty in 30 veins with stent placement in 5 vessels when a flap occurred. Overall vessel diameter increased from 2.6+/-1.6 to 6.6+/-2.4 mm (P<0.0001). There were 4 procedure-related adverse events but no long-term sequelae. Immediate follow-up showed improved flow to involved lung segments. At a median follow-up of 43 weeks (2-92), although repeat angioplasty for restenosis was necessary in 8 of 17 patients, 15 of 17 patients currently have no or minimal persistent symptoms.


CONCLUSIONS
Pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation is often misdiagnosed. Although further follow-up is necessary to determine long-term success, our data indicate better pulmonary vein flow and symptomatic improvement in the majority of patients undergoing dilation of postablation pulmonary vein stenosis.
Qureshi
Athar M
AM
Department of Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Prieto
Lourdes R
LR
Latson
Larry A
LA
Lane
Geoffrey K
GK
Mesia
C Igor
CI
Radvansky
Penelope
P
White
Richard D
RD
Marrouche
Nassir F
NF
Saad
Eduardo B
EB
Bash
Dianna L
DL
Natale
Andrea
A
Rhodes
John F
JF
D000800:Angioplasty, Balloon / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed