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(Circulation. 2003;108:1336.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

Athar M. Qureshi, MD; Lourdes R. Prieto, MD; Larry A. Latson, MD; Geoffrey K. Lane, MD; C. Igor Mesia, MD; Penelope Radvansky, RN; Richard D. White, MD; Nassir F. Marrouche, MD; Eduardo B. Saad, MD; Dianna L. Bash, RN; Andrea Natale, MD; John F. Rhodes, MD

From the Departments of Pediatric Cardiology (A.M.Q., L.R.P., L.A.L, G.K.L., C.I.M., P.R., J.F.R.), Radiology (R.D.W.), and Cardiovascular Medicine (R.D.W., N.F.M., E.B.S., D.L.B., A.N.), The Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to John F. Rhodes, MD, Department of Pediatric Cardiology, Pediatric Catheterization Laboratory, The Cleveland Clinic Foundation, Center for Pediatric and Congenital Heart Diseases/M41, 9500 Euclid Ave, Cleveland, OH 44195. E-mail rhode028{at}mc.duke.edu

Received March 7, 2003; revision received June 13, 2003; accepted June 16, 2003.

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.

Key Words: stenosis • ablation • fibrillation • angioplasty

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