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(Circulation. 2008;118:e834-e835.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Constrictive Pericarditis After Catheter Ablation for Atrial Fibrillation

Syed Y. Ahsan, MRCP; James C. Moon, MD, MRCP; Martin P. Hayward, MS, FRCS; Anthony W.C. Chow, MD, FRCP; Pier D. Lambiase, PhD, MRCP

From the Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, London, UK.

Correspondence to Pier D. Lambiase, PhD, MRCP, Senior Lecturer and Consultant Cardiologist, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL 16–18 Westmoreland St, London W1G 8PH, UK. E-mail pier.lambiase@uclh.nhs.uk

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 70-year-old man with paroxysmal atrial fibrillation was referred for pulmonary vein isolation. Past medical history included ischemic heart disease and a right hemicolectomy for Duke’s C carcinoma 10 years previously. Presenting ECG showed sinus rhythm with a normal axis and evidence of left atrial enlargement (Figure 1). Preoperative echocardiography demonstrated normal left ventricular structure and function. After routine single transseptal puncture, retrograde pulmonary venography was performed. This demonstrated 2 large right pulmonary veins and a left common pulmonary vein. Subsequently, an uncomplicated wide-area circumferential ablation of the pulmonary vein antra and right atrial isthmus ablation were performed successfully.

View larger version (63K):   Figure 1. Presenting ECGs. Sinus rhythm (left) and atrial fibrillation (bottom).

Three months postoperatively, the patient developed marked dyspnea with an elevated jugular venous pressure and ankle edema. Chest x-ray (Figure 2) showed pleural effusions and upper lobe blood diversion. Echocardiography demonstrated normal left ventricular function but showed pericardial thickening. Cardiovascular magnetic resonance imaging excluded pulmonary vein stenosis but demonstrated circumferential pericardial thickening to a maximum of 1 cm and ventricular interdependence with inspiratory septal flattening on real-time imaging, characteristic of constrictive pericarditis.

View larger version (140K):   Figure 2. Posteroanterior chest x-ray showing blunting of the left costophrenic angle and increased pleural thickening in the right midzone consistent with pleural effusions. Upper lobe blood diversion and an increased cardiothoracic ratio can also be seen.

Initial medical management with diuretics and oral prednisolone only partly resolved signs and symptoms. Successive cardiovascular magnetic resonance imaging (Figure 3) demonstrated a reduction in . . . [Full Text of this Article]