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Pulmonary Vein Stenosis After Ablation of Atrial Fibrillation
Study Questions:
What is the risk of pulmonary vein stenosis (PVS) in patients undergoing radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?
Methods:
Magnetic resonance imaging or computed tomography was performed before and after PV antrum isolation by RFCA in 976 patients in 2005-2016. PVS was classified as mild (30-50% reduction in diameter), moderate (50-70%), or severe (>70%). The post-RFCA imaging was performed at a mean of 6 months of follow-up.
Results:
Mild PVS was found in 31.4% of patients, moderate PVS in 4.3%, and severe PVS in 0.7%. Only one patient (0.1%) reported severe dyspnea attributable to PVS. This patient had subtotal occlusion of the left inferior PV and severe stenosis in the left superior PV and required stenting.
Conclusions:
The risk of PVS requiring intervention following antral PV isolation is very small. Routine screening for post-RFCA PVS is not necessary.
Perspective:
A large international survey reported that the prevalence of severe PVS after RFCA to isolate the PVs was <1%. However, this survey was voluntary, leaving open the possibility of under-reporting of complications. It is reassuring that this single-center cohort study confirms that the risk of severe PVS is <1%. The prevalence of mild and moderate PVS was surprisingly high, strongly suggesting that RFCA often was performed at or within the PV ostia. This is rarely necessary with adequate antral ablation.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Imaging Techniques, Catheter Ablation, Constriction, Pathologic, Coronary Occlusion, Coronary Stenosis, Dyspnea, Magnetic Resonance Imaging, Pulmonary Veins, Stents
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