Published Online
on November 17, 2003

A more recent version of this article appeared on December 23, 2003

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Submitted on July 10, 2003
Revised on September 16, 2003
Accepted on September 22, 2003

Pulmonary Vein Stenosis After Radiofrequency Ablation of Atrial Fibrillation. Functional Characterization, Evolution, and Influence of the Ablation Strategy

Eduardo B. Saad MD, Antonio Rossillo MD, Cynthia P. Saad MD, David O. Martin MD, Mandeep Bhargava MD, Demet Erciyes MD, Dianna Bash RN, Michelle Williams-Andrews RN, Salwa Beheiry RN, Nassir F. Marrouche MD, James Adams MD, Ennio Pisanò MD, Raffaele Fanelli MD, Domenico Potenza MD, Antonio Raviele MD, Aldo Bonso MD, Sakis Themistoclakis MD, Joannes Brachmann MD, Walid I. Saliba MD, Robert A. Schweikert MD, and Andrea Natale MD^*

From the Center for Atrial Fibrillation (E.B.S., D.O.M., M.B., D.B., M.W.-A., N.F.M., W.I.S., R.A.S., D.E., A.N.) and Department of Pulmonary and Critical Care Medicine (C.P.S.), Cleveland Clinic Foundation, Cleveland, Ohio; the Department of Cardiology, Umberto I Hospital, Mestre-Venice, Italy (A. Rossillo, A. Raviele, A.B., S.T.); the Department of Cardiology, Marin Heart Institute, San Francisco, Calif (S.B., J.A.); the Department of Cardiology, Casa Sollievo della Soffrenza, S. Giovanni Rotondo, Italy (E.P., R.F., D.P.); and the Department of Cardiology, Klinikum Coburg, Coburg, Germany (J.B.).

^* To whom correspondence should be addressed. E-mail: natalea{at}ccf.org.

Background--Pulmonary vein (PV) stenosis is a complication of ablation for atrial fibrillation. The impact of different ablation strategies on the incidence of PV stenosis and its functional characterization has not been described.

Methods and Results--PV isolation was performed in 608 patients. An electroanatomic approach was used in 71 and circular mapping in 537 (distal isolation, 25; ostial isolation based on PV angiography, 102; guided by intracardiac echocardiography, 140; with energy delivery based on visualization of microbubbles, 270). Severe (70%) narrowing was detected in 21 patients (3.4%), and moderate (50% to 69%) and mild (<50%) narrowing occurred in 27 (4.4%) and 47 (7.7%), respectively. Severe stenosis occurred in 15.5%, 20%, 2.9%, 1.4%, and 0%, respectively. Development of symptoms was correlated with involvement of >1 PV with severe narrowing (P=0.01), whereas all patients with mild and moderate narrowing were asymptomatic. In the latter group, lung perfusion (V/Q) scans were normal in all but 4 patients. All patients with severe stenosis had abnormal perfusion scans.

Conclusions--V/Q scans are useful to assess the functional significance of PV stenosis. Mild and moderate degrees of PV narrowing are not associated with development of symptoms and seem to have no or minimal detrimental effect on pulmonary flow. The incidence of severe PV stenosis seems to be declining with better imaging techniques to ensure ostial isolation and to guide power titration. Mild narrowing 3 months after ablation does not preclude future development of severe stenosis and should be assessed with repeat imaging studies.

Key words: fibrillation • veins • ablation • stenosis

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