Key result
The natural course of untreated pulmonary vein stenosis showed a spontaneous reduction in mean stenosis grade from 57% to 45% (P=0.05) over a mean follow-up of 43 months.
Why the study?
Thermal injury during radiofrequency ablation of AF can cause pulmonary vein stenosis, but its natural course regarding stenosis grade, symptoms, and mortality during long-term follow-up needed analysis.
Does untreated pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation spontaneously improve over time?
Observational (n=38)
No
Does untreated pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation spontaneously improve over time?
Acquired pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation shows spontaneous reduction in stenosis grade and symptoms over a 3.5-year follow-up, suggesting routine follow-up imaging may not be necessary unless additional ablation is performed.
INTRODUCTION: Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). The aim of the present study was to analyze the natural course of RFA-induced PVS with regard to the grade of stenosis, clinical symptoms, and mortality during long-term follow-up. METHODS AND RESULTS: All patients with follow-up imaging for radiofrequency-induced untreated PVS were retrospectively assessed. From 2004 to 2017, the total rate of PVS following AF ablation in our center was 0.78% (87 of 11 103). Thirty-eight patients with a total of 54 untreated PVS underwent follow-up including imaging scan. The mean degree of stenosis at the time of diagnosis was 57% ± 27% vs 45% ± 35% (P = .05) after a mean follow-up of 43 ± 31 months. There was a shift in severity of the PVS: 18 of 54 (33%) vs 16 of 54 (30%) severe PVS, 19 of 54 (35%) vs 10 of 54 (18%) moderate PVS, and 17 of 54 (32%) vs 28 of 54 (52%) mild PVS (P = .0001). The mean symptom score decreased significantly during follow-up (1.8 ± 1.0 vs 0.4 ± 0.5, P = .0001). Each of the four patients with progression of PVS underwent another pulmonary vein isolation for AF recurrence following pulmonary vein reconduction during follow-up period. CONCLUSION: This study showed a spontaneous reduction in stenosis grade and symptoms of PVS over a 3.5-year follow-up. Consequently, routine follow-up imaging of PVS seems not to be necessary. However, additional RF energy delivery to stenotic pulmonary veins should be avoided if possible. In case of conduction recovery, the ablation line should be done wide-antrally and follow-up imaging of PVS is recommended.
No takes yet. Share an insight, caveat, or question.
Schoene et al. (2019) conducted an observational in Acquired pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation (n=38). Natural course of untreated pulmonary vein stenosis vs. Baseline (time of diagnosis) was evaluated on Mean degree of stenosis (p=0.05). The natural course of untreated pulmonary vein stenosis showed a spontaneous reduction in mean stenosis grade from 57% to 45% (P=0.05) over a mean follow-up of 43 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: