Abstract 13583: Impact of Follow Up CT Scans on the Distribution and Severity of PV Stenosis at Diagnosis
Background: Pulmonary vein (PV) stenosis is a known complication of ablative intervention for atrial fibrillation (AF). Over the last several years, the practice of pulmonary vein surveillance with CT imaging has been eliminated in many centers. The impact of this evolving practice on the extent of PV stenosis at diagnosis is unclear.
Methods: Data from 76 patients referred for PV stenosis intervention were compared between those with or without a screening CT study at 3-6 months post ablation.
Results: Of 76 patients included in the study, 62 had undergone 1 ablation and 14 underwent ≥2 AF ablations. These patients had 156 abnormal veins, 137 of which were stenosed >50%, 36 (23%) with moderate (50-75%) stenosis, 70 (45%) with severe stenosis (>75%) and 31 (19%) were occluded. In 36 patients identified by a 3-month CT scan, 60 pulmonary veins were stenosed, 23 (38%) PVs with moderate and 30 (50%) had severe stenosis. In contrast, the diagnosis of PV stenosis was established at 14 ± 16 months in those without f/u CT study. Of those 40 patients, 77 pulmonary veins were stenosed: 13 (16%) had moderate stenosis and 40 (52%) had severe stenosis. Occlusion was noted in 24 (31%) PVs without f/u CT study vs. 7 (11%) with f/u CT studies [p=0.002]. Hemoptysis was present in 2 (3%) patients in CT f/u group vs. 11 (31%) without f/u CT [p=0.03].
Conclusion: Patients without surveillance study were more likely to have severe PV stenosis/occluded veins and hemoptysis than those with surveillance. These data document the increment of severity of PV stenosis at detection in those patients not undergoing routine surveillance CT requiring additional intervention. This provides a strong rationale for continued CT surveillance or strong encouragement of patient education for early reporting of symptoms in the absence of such scanning.
- © 2012 by American Heart Association, Inc.