Pulmonary Vein Stenosis Complicating Catheter Ablation of Focal Atrial Fibrillation

Scanavacca, Maurício; Kajita, Luiz J.; Vieira, Marcelo Luís Campos; Sosa, Eduardo

doi:10.1111/j.1540-8167.2000.tb00030.x

Cited by 96 publications

(61 citation statements)

References 9 publications

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“…Currently, there are no published series on the transcatheter management of PVS secondary to RFA, and the few published case reports available have variable results. 13,14,18,19,22 Our results show that transcatheter management performed early after diagnosis and aimed at producing a widely patent pulmonary vein ostium can significantly improve the patient's outcome. Importantly, our patients had an overall significant improvement in NYHA functional class.…”

Section: Discussionmentioning

confidence: 78%

“…[12][13][14][15][16][17][18][19][21][22] Although previous reports have demonstrated MRI to be superior to transesophageal echocardiography in defining pulmonary venous anatomy, 17 there are few data comparing MRI to spiral CT scan. For our patients, we consistently used spiral CT scan as the imaging modality to delineate abnormalities of pulmonary venous anatomy as well as associated abnormalities of the mediastinum/hilum (eg, enlarged nodes) or of the lung (eg, focal edema or hemorrhage).…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

et al. 2003

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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. Methods and 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.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

et al. 2003

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“…2,[13][14][15] However, late occurrence after some weeks or months has also been reported. [15][16][17][18][19] In this study, a delayed progression of DR/stenosis has been detected in 8.3%. These observations support the assumption that progression of early stenosis without clinical symptoms or of DR to a severe stenosis causing clinical symptoms (eg, severe segmental pulmonary hypertension) may occur and emphasize the necessity of follow-up investigations.…”

Section: Discussionmentioning

confidence: 82%

Pulmonary Vein Diameter Reduction After Radiofrequency Catheter Ablation for Paroxysmal Atrial Fibrillation Evaluated by Contrast-Enhanced Three-Dimensional Magnetic Resonance Imaging

et al. 2003

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Background-Radiofrequency catheter ablation (RFCA) is a promising intervention to treat atrial fibrillation. However, pulmonary vein (PV) stenosis after RFCA has been reported. The aim of this study was to investigate the incidence and time course of pulmonary vein stenosis after RFCA within a period of 3 months. Contrast-enhanced magnetic resonance angiography (MRA) was used to visualize pulmonary veins and was compared with radiographic angiography. Methods and Results-Forty-six consecutive patients with symptomatic paroxysmal atrial fibrillation had RFCA in the orifice of 138 pulmonary veins. Comparison of diameters measured in 44 untreated vessels either by radiographic angiography or with MRA established the reliability of MRA (rϭ0.934). MRA measurements revealed an incidence of relevant diameter reductions of Ն25% or stenosis of Ն50% after RFCA of 25 of 138 (18.1%) treated vessels 1 day and/or 3 months after ablation. A progression of diameter reduction after RFCA was observed in 8.3% (maximum 75%), whereas a regression was observed in 6.3% of treated PVs. Ablation at a radial angle of Ͼ180°of a pulmonary vein orifice increased the risk of diameter reduction significantly compared with ablation at a radial angle Յ180°(Pϭ0.002). Conclusions-The occurrence and progression of PV stenosis is a potential significant complication of RFCA in the orifice of pulmonary veins. These findings may have an impact on the technical performance of this intervention. In addition, long-term studies will be necessary to evaluate lumen reduction over time. MRA is a noninvasive, reproducible imaging modality for this purpose.

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“…The clinical presentation of patients with severe PV stenosis varies from asymptomatic to highly symptomatic with recurrent pneumonia, hemoptysis, cough, dyspnea and chest pain. Because the relief of acquired PV stenosis is difficult to achieve with balloon angioplasty and stenting, 12,13,61,62 preventive strategies are mandatory, including the placing of isolation lines outside the PV orifice, reduction of the target temperature and applied energy, and the introduction of ICE or special navigation systems for catheter positioning.…”

Section: Complicationsmentioning

confidence: 99%

“…The new PVI strategies were developed, and have become established as principal and standardized techniques, to avoid PV ostial narrowing or obstruction [11][12][13][14] and residual PV peri-ostial or antral foci are recognized as potential risks and limitations of segmental PV ostial isolation. 10 These techniques are CPVA, 10,[15][16][17][18][19] PV antrum isolation (PVAI), [20][21][22][23] and extensive encircling ipsilateral PVI (EEPVI), [24][25][26] which target either the atrial tissue surrounding the PVs or the border between the LA and PV antrum.…”

Section: Ablation Strategies Targeting the Pv And Itsmentioning

confidence: 99%

Catheter Ablation Therapy for Atrial Fibrillation Current Advancements in Strategies

Iesaka

Otomo

Nagata

et al. 2007

Circ J

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Curing atrial fibrillation (AF) by catheter ablation has significantly improved patient morbidity and mortality. The circumferential pulmonary vein isolation technique is established as the principal procedure, with a high cure rate and acceptable safety, for paroxysmal AF, but new adjunctive ablation strategies targeting the AF substrates and sources for long-standing persistent/chronic AF have been developed. These new techniques include linear ablation, complex fractionated atrial electrogram guided ablation, dominant frequency map-guided ablation, ganglionated plexi ablation and disconnection of the coronary sinus and superior vena cava to ablate the AF substrates and sources. The long-term usefulness of the established technique and these innovative adjunctive approaches for the treatment of AF remains to be investigated. (Circ J 2007; Suppl A: A-82 -A-89)

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Pulmonary Vein Stenosis Complicating Catheter Ablation of Focal Atrial Fibrillation

Abstract: Multiple radiofrequency pulses applied inside the pulmonary veins ostia can induce severe pulmonary venous stenosis and veno-occlusive pulmonary syndrome.

Cited by 96 publications

References 9 publications

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

Pulmonary Vein Diameter Reduction After Radiofrequency Catheter Ablation for Paroxysmal Atrial Fibrillation Evaluated by Contrast-Enhanced Three-Dimensional Magnetic Resonance Imaging

Catheter Ablation Therapy for Atrial Fibrillation Current Advancements in Strategies

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