Radiofrequency catheter ablation caused pulmonary vein diameter reductions ≥25% or stenosis ≥50% in 18.1% of treated vessels, with higher risk at ablation angles >180 degrees (P=0.002).
Cohort (n=46)
What is the incidence and time course of pulmonary vein stenosis after radiofrequency catheter ablation for paroxysmal atrial fibrillation?
Radiofrequency catheter ablation for paroxysmal atrial fibrillation carries a significant risk of pulmonary vein stenosis, particularly when ablation involves a radial angle >180 degrees, which can be reliably monitored using contrast-enhanced MRA.
BACKGROUND: Radiofrequency catheter ablation (RFCA) is a promising intervention to treat atrial fibrillation. However, pulmonary vein (PV) stenosis after RFCA has been reported. The aim of this study was to investigate the incidence and time course of pulmonary vein stenosis after RFCA within a period of 3 months. Contrast-enhanced magnetic resonance angiography (MRA) was used to visualize pulmonary veins and was compared with radiographic angiography. METHODS AND RESULTS: Forty-six consecutive patients with symptomatic paroxysmal atrial fibrillation had RFCA in the orifice of 138 pulmonary veins. Comparison of diameters measured in 44 untreated vessels either by radiographic angiography or with MRA established the reliability of MRA (r=0.934). MRA measurements revealed an incidence of relevant diameter reductions of > or =25% or stenosis of > or =50% after RFCA of 25 of 138 (18.1%) treated vessels 1 day and/or 3 months after ablation. A progression of diameter reduction after RFCA was observed in 8.3% (maximum 75%), whereas a regression was observed in 6.3% of treated PVs. Ablation at a radial angle of >180 degrees of a pulmonary vein orifice increased the risk of diameter reduction significantly compared with ablation at a radial angle < or =180 degrees (P=0.002). CONCLUSIONS: The occurrence and progression of PV stenosis is a potential significant complication of RFCA in the orifice of pulmonary veins. These findings may have an impact on the technical performance of this intervention. In addition, long-term studies will be necessary to evaluate lumen reduction over time. MRA is a noninvasive, reproducible imaging modality for this purpose.
Dill et al. (Tue,) conducted a cohort in symptomatic paroxysmal atrial fibrillation (n=46). Radiofrequency catheter ablation (RFCA) was evaluated on Incidence of relevant diameter reductions of ≥25% or stenosis of ≥50% 1 day and/or 3 months after ablation. Radiofrequency catheter ablation caused pulmonary vein diameter reductions ≥25% or stenosis ≥50% in 18.1% of treated vessels, with higher risk at ablation angles >180 degrees (P=0.002).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: