Incidence and Predictors of Pulmonary Vein Stenosis Following Catheter Ablation of Atrial Fibrillation Using the Anatomic Pulmonary Vein Ablation Approach: Results from Paired Magnetic Resonance Imaging

Abstract

The results of this study demonstrate that detectable PV narrowing occurs in 38% of PVs following anatomic PV ablation. Moderate or severe PV stenosis occurs in 3.8% of PVs. The high incidence of mild stenosis likely reflects reverse remodeling rather than pathological PV stenosis. The probability of moderate or severe PV stenosis appears to be related to creation of individual encircling rather than encircling in pairs lesion.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…434,505,778,1142,1144,1150,1151 This variation results from differences in the ablation technique, definitions of PV stenosis, the intensity of screening for this complication, and the date the study was performed. When PV ablation for treating AF began in the late 1990s, investigators were unaware that PV stenosis was a potential complication.…”

The State of the Art in Pulmonary Vein Stenosis - Diagnosis & Treatment

“…[8][9][10][11] Delivery of radiofrequency energy in the antrum rather than the ostium of the pulmonary vein, titration of energy application or use of alternative energy sources, use of intracardiac echocardiography to guide ablations, and image integration of multislice computer tomography performed prior to PVI with electroanatomical mapping during PVI are some of the most important technical advances contributing to the decline. [9][10][11][12][13][14][15] Recognizing that there is no consensus at this time on routine screening for pulmonary vein stenosis after PVI, 16 we followa protocol at our institution to assure that the small number of patients who still develop significant pulmonary vein stenosis is not missed. Imaging is performed 3 months following PVI, and repeated 3 months later only if significant stenosis is detected at the time of the first scan.…”

“…[9][10][11][12][13][14][15] Recognizing that there is no consensus at this time on routine screening for pulmonary vein stenosis after PVI, 16 we followa protocol at our institution to assure that the small number of patients who still develop significant pulmonary vein stenosis is not missed. Imaging is performed 3 months following PVI, and repeated 3 months later only if significant stenosis is detected at the time of the first scan.…”

Ablation Versus Drugs: What Is the Best First-Line Therapy for Paroxysmal Atrial Fibrillation?

“…The published incidence of Pv stenosis varies widely from 0% to 38%. [33][34][35] This variation results from differences in the ablation technique, definition of Pv stenosis, and intensity of screening. The worldwide survey of AF ablation reported a 0.32% incidence of acute Pv stenosis and a 1.3% incidence of persistent Pv stenosis.…”

“…8 Symptoms of Pv stenosis include chest pain, dyspnea, cough, hemoptysis, recurrent lung infections, and symptoms of pulmonary hypertension. 34,35 It is unknown whether early diagnosis and treatment of asymptomatic Pv stenosis provide any long-term advantage to the patient.…”