title: Pulmonary vein stenosis after pulmonary vein isolation using duty-cycled unipolar/bipolar radiofrequency ablation guided by intracardiac echocardiography.
abstract: OBJECTIVE
  Concerning rates of pulmonary vein (PV) stenosis were reported following PV isolation (PVI) with a circular pulmonary vein ablation catheter (PVAC). As this may depend on intraprocedural imaging, we evaluated the incidence of PV stenosis in patients undergoing PVAC-PVI with continuous surveillance by intracardiac echocardiography (ICE).
  
  
  METHODS
  Multi-slice computed tomography was performed before and 3 months after PVAC-PVI with continuous ICE surveillance in 30 patients (37 % male, 65 ± 9 years). PV areas at two levels (ostial and 1 cm distally) and left atrial (LA) volumes were measured. PV area/LA volume ratio was calculated to correct for reverse LA remodelling. PV stenosis was classified as mild (25-50 %), moderate (50-75 %) and severe (> 75 %).
  
  
  RESULTS
  One hundred sixteen veins were isolated with PVAC with additional touch-up ablation in one patient. One patient was excluded from analysis for untriggered CT acquisition. Left atrial volume decreased from 109.1 ± 30.9 cm(3) before to 98.4 ± 34.4 cm(3) after ablation (p < 0.05). Overall, PV areas decreased ostially from 209.0 ± 80.3 mm(2) to 171.2 ± 74.6 mm(2) (p < 0.0001) and distally from 155.2 ± 61.5 mm(2) to 141.0 ± 51.3 mm(2) (p < 0.0001). After adjustment for LA volume reduction, PV area significantly reduced only at the ostial level (p = 0.0069). Mild PV stenosis (ostial/distal) was detected in 17/9 PVs (14.7 %/7.8 %) and moderate PV stenosis in 7/0 PVs (6.0 %/0 %). PV stenosis occurred more often in superior PVs (p = 0.0004). No severe PV stenosis occurred. All patients remained asymptomatic.
  
  
  CONCLUSIONS
  While the use of ICE does not fully prevent the occurrence of ostial PV stenosis after PVAC-PVI, no significant narrowing in distal PVs was observed. Superior PVs are prone to PV stenosis after PVAC-PVI.
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center, Hugstetter Str. 55, 79106, Freiburg, Germany. stefan.asbach@universitaets-herzzentrum.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Asbach
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Schluermann
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: Luca
authors.initials: L
authors.lastname: Trolese
authors.affiliation: Department of Radiology, University Hospital, Freiburg, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Langer
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.affiliation: Department of Radiology, University Hospital, Freiburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Krauss
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015897:Comorbidity; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011667:Pulmonary Veins / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
keywords: Ablation; Atrial fibrillation; Pulmonary vein ablation catheter; Pulmonary vein stenosis