Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy.
BACKGROUND
Pulmonary vein (PV) stenosis is a complication of ablation for atrial fibrillation. The impact of different ablation strategies on the incidence of PV stenosis and its functional characterization has not been described.


RESULTS
PV isolation was performed in 608 patients. An electroanatomic approach was used in 71 and circular mapping in 537 (distal isolation, 25; ostial isolation based on PV angiography, 102; guided by intracardiac echocardiography, 140; with energy delivery based on visualization of microbubbles, 270). Severe (> or =70%) narrowing was detected in 21 patients (3.4%), and moderate (50% to 69%) and mild (<50%) narrowing occurred in 27 (4.4%) and 47 (7.7%), respectively. Severe stenosis occurred in 15.5%, 20%, 2.9%, 1.4%, and 0%, respectively. Development of symptoms was correlated with involvement of >1 PV with severe narrowing (P=0.01), whereas all patients with mild and moderate narrowing were asymptomatic. In the latter group, lung perfusion (V/Q) scans were normal in all but 4 patients. All patients with severe stenosis had abnormal perfusion scans.


CONCLUSIONS
V/Q scans are useful to assess the functional significance of PV stenosis. Mild and moderate degrees of PV narrowing are not associated with development of symptoms and seem to have no or minimal detrimental effect on pulmonary flow. The incidence of severe PV stenosis seems to be declining with better imaging techniques to ensure ostial isolation and to guide power titration. Mild narrowing 3 months after ablation does not preclude future development of severe stenosis and should be assessed with repeat imaging studies.
Saad
Eduardo B
EB
Center for Atrial Fibrillation, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Rossillo
Antonio
A
Saad
Cynthia P
CP
Martin
David O
DO
Bhargava
Mandeep
M
Erciyes
Demet
D
Bash
Dianna
D
Williams-Andrews
Michelle
M
Beheiry
Salwa
S
Marrouche
Nassir F
NF
Adams
James
J
Pisanò
Ennio
E
Fanelli
Raffaele
R
Potenza
Domenico
D
Raviele
Antonio
A
Bonso
Aldo
A
Themistoclakis
Sakis
S
Brachmann
Joannes
J
Saliba
Walid I
WI
Schweikert
Robert A
RA
Natale
Andrea
A
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011859:Radiography