August 13, 2026Circulation Journal0 citationsOpen Access
Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation ― A Computed Tomography-Based Analysis of Incidence and Risk Factors ―
Key Result
Radiofrequency ablation for atrial fibrillation was associated with a 16% incidence of pulmonary vein stenosis in a CT-enriched cohort, whereas no cases were observed after pulsed field ablation.
Key Points
- To determine the incidence of pulmonary vein stenosis following radiofrequency ablation for atrial fibrillation and identify associated risk factors.
- Performed computed tomography imaging to assess pulmonary vein stenosis post-ablation.
- Analyzed data for incidence and potential risk factors associated with stenosis.
- Compared findings to identify patterns in patients with asymptomatic versus symptomatic outcomes.
- Found a significant incidence of pulmonary vein stenosis after radiofrequency ablation.
- Identified specific risk factors that contribute to the development of the condition.
- Noted many cases of pulmonary vein stenosis were asymptomatic, highlighting the need for routine imaging.
Study Design
Type
Observational (n=276)
Multicenter
No
Structured PICO
P
Population
276 patients with atrial fibrillation who underwent 339 ablation procedures and had both pre- and postprocedural CT imaging, followed for a median of 226 days.
E
Exposure
Radiofrequency ablation (standard power long duration, high power short duration, or very high power short duration) or pulsed field ablation for atrial fibrillation
O
Outcome
Incidence of pulmonary vein stenosis (defined as ≥50% reduction in PV lumen diameter) assessed by postprocedural CT imagingsafety
In a CT-enriched cohort, the incidence of subclinical pulmonary vein stenosis after RF ablation was 16%, highlighting the potential underestimation of this complication and the need for risk-adapted imaging follow-up.
Main Result
Absolute Event Rate: 16% vs 0%
Limitations
- Single-center retrospective design
- Use of a CT-enriched cohort where postprocedural imaging was frequently obtained for clinical indications, introducing potential selection bias
- PV stenosis may progress over time, and early imaging may underestimate its severity
- Procedural heterogeneity and residual confounding due to evolving ablation strategies, catheter selection, and operator experience
- Analysis was performed on a per-procedure basis rather than a per-vein basis
- Limited pulsed field ablation sample size and small number of symptomatic cases
Abstract
Background: The true incidence of pulmonary vein (PV) stenosis after radiofrequency (RF) ablation for atrial fibrillation remains uncertain because routine imaging surveillance is not universally performed and many cases of PV stenosis are asymptomatic.