This Article Full Text Full Text (PDF) All Versions of this Article: 108/11/1336    most recent 01.CIR.0000086322.21781.6Av1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Qureshi, A. M. Articles by Rhodes, J. F. Search for Related Content PubMed PubMed Citation Articles by Qureshi, A. M. Articles by Rhodes, J. F. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Related Collections Primary prevention Secondary prevention Restenosis Ablation/ICD/surgery Other Treatment CT and MRI

(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

This article has been cited by other articles:

				D. R. Holmes Jr, K. H. Monahan, and D. Packer Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation: Clinical Spectrum and Interventional Considerations J. Am. Coll. Cardiol. Intv., April 1, 2009; 2(4): 267 - 276. [Abstract] [Full Text] [PDF]

				D. Nehra, M. Liberman, P. A. Vagefi, N. Evans, I. Inglessis, R. L. Kradin, J. Ono, D. J. Kanarek, and H. A. Gaissert Complete Pulmonary Venous Occlusion After Radiofrequency Ablation for Atrial Fibrillation Ann. Thorac. Surg., January 1, 2009; 87(1): 292 - 295. [Abstract] [Full Text] [PDF]

				T. H. Hauser, D. C. Peters, J. V. Wylie, and W. J. Manning Evaluating the left atrium by magnetic resonance imaging Europace, November 1, 2008; 10(suppl_3): iii22 - iii27. [Abstract] [Full Text] [PDF]

				P Kojodjojo, T Wong, A R Wright, O M Kon, W Oldfield, P Kanagaratnam, D W Davies, and N S Peters Pulmonary venous stenosis after treatment for atrial fibrillation BMJ, April 12, 2008; 336(7648): 830 - 832. [Full Text] [PDF]

				J. E. Marine Catheter Ablation Therapy for Supraventricular Arrhythmias JAMA, December 19, 2007; 298(23): 2768 - 2778. [Abstract] [Full Text] [PDF]

				L. A. Latson and L. R. Prieto Congenital and Acquired Pulmonary Vein Stenosis Circulation, January 2, 2007; 115(1): 103 - 108. [Full Text] [PDF]

				O. M. Wazni, T. S. Fahmy, A. Natale, S. K. Aberegg, D. Majure, J. Auer, G. Lamm, B. Eber, H. Oral, C. Pappone, et al. Circumferential pulmonary-vein ablation for atrial fibrillation. N. Engl. J. Med., May 25, 2006; 354(21): 2289 - 2291. [Full Text] [PDF]

				F. Salamon, R. Hirsch, R. Tur-Kaspa, and M. R. Kramer Clinical problem-solving. Search for the complication. N. Engl. J. Med., March 2, 2006; 354(9): 957 - 963. [Full Text] [PDF]

				J. Edelson, R. Shah, and D. Ost A 45-Year-Old Man With Left Lung Hypoperfusion and Possible Pulmonary Embolism Chest, August 1, 2005; 128(2): 1032 - 1036. [Full Text] [PDF]

				T. Arentz, R. Weber, N. Jander, G. Burkle, J. von Rosenthal, T. Blum, J. Stockinger, L. Haegeli, F. J. Neumann, and D. Kalusche Pulmonary haemodynamics at rest and during exercise in patients with significant pulmonary vein stenosis after radiofrequency catheter ablation for drug resistant atrial fibrillation Eur. Heart J., July 2, 2005; 26(14): 1410 - 1414. [Abstract] [Full Text] [PDF]

				D. L. Packer, P. Keelan, T. M. Munger, J. F. Breen, S. Asirvatham, L. A. Peterson, K. H. Monahan, M. F. Hauser, K. Chandrasekaran, L. J. Sinak, et al. Clinical Presentation, Investigation, and Management of Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation Circulation, February 8, 2005; 111(5): 546 - 554. [Abstract] [Full Text] [PDF]