Published online before print February 3, 2003, doi: 10.1161/01.CIR.0000048146.81336.1D
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(Circulation. 2003;107:845.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Pulmonary Vein Diameter Reduction After Radiofrequency Catheter Ablation for Paroxysmal Atrial Fibrillation Evaluated by Contrast-Enhanced Three-Dimensional Magnetic Resonance Imaging
From the Department of Cardiology (T.D., T.N., O.E., C.B., A.E., C.W.H., H.-F.P.), Kerckhoff Heart Center, Bad Nauheim, Germany; the Department of Radiology (G.B.), Kerckhoff Heart Center, Bad Nauheim, Germany; and the Department of Cardiac MRI (A.J.), Royal Brompton Hospital, London, UK.
Correspondence to Thorsten Dill, MD, Kerckhoff Heart Center, Department of Cardiology/Cardiac MRI, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. E-mail thorsten.dill{at}kerckhoff.med.uni-giessen.de
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 (r=0.934). MRA measurements revealed an incidence of relevant diameter reductions of 
25% or stenosis of 50% 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 >180° of a pulmonary vein orifice increased the risk of diameter reduction significantly compared with ablation at a radial angle 
180° (P=0.002).
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.
Key Words: magnetic resonance imaging • catheter ablation • veins • fibrillation
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