Abstract 2105: Early Dilation/stenting of Pulmonary Vein Occlusion Following Catheter Ablation for Atrial Fibrillation Restores Pulmonary Flow and Prevents Associated Lung Diseases
Introduction: Pulmonary vein occlusion (PVO) is a rare complication that can develop following radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). As a consequence, arterial flow to the affected lung segment may be compromised predisposing to detrimental sequelae. We present the impact of timely intervention for PVO on the corresponding lung.
Methods: Data from 17 patients with complete occlusion (≥ 95% stenosis) of at least one pulmonary vein (PV) were prospectively collected after RFA for AF using different ablation strategies. PVO was diagnosed by CT scan and the corresponding lung was physiologically evaluated by quantitative lung perfusion scans. The percent stenoses of the ipsilateral veins (PVO/PVS) were added together [Cumulative unilateral stenosis (CUS)] and correlations were drawn with the quantitative perfusion before and after intervention. Pulmonary intervention was attempted in all patients, and the success of the procedure was evaluated by the decrease of CUS by CT scan, as well as the improvement of the lung perfusion post intervention.
Results: Out of the 17 patients, intervention was performed in 15 [7 (46.7%) had dilatation only and 8(54.3%) had dilation and stents] while restenosis occurred in 46%. The improvement of CUS post intervention was considerable in the successful patients [mean difference 27.5% (95%CI 11.73–43.27) P<0.005]. The number of interventions and the improvement in the CUS correlated well with the improvement in lung perfusion (r = 0.765 P<0.001), and r =0.929, p<0.01 respectively). Importantly, following the diagnosis of PVO, the time to intervention was significantly different between the successfully dilated and failed or restenosed patients (2.58±1.88 vs 12 .6 ± 10.74 months p<0.05). Moreover, regardless of the degree of improvement in CUS, the improvement in perfusion had a significant negative correlation with the delay in intervention (r =−0.497 p<0.05).
Conclusion: Patients with concomitant ipsilateral PVO/PVS require early and repeated pulmonary interventions for restoration of pulmonary flow and prevention of associated lung disease.