Catheter ablation for atrial fibrillation resulted in total pulmonary vein occlusion in 3 of 239 patients (1.3%), presenting with severe respiratory symptoms mimicking primary lung disease.
Observational (n=239)
No
Does catheter ablation for atrial fibrillation lead to pulmonary vein occlusion?
Total pulmonary vein occlusion is a severe complication of atrial fibrillation ablation that can mimic primary lung disease and is prone to restenosis after recanalization.
INTRODUCTION: Catheter ablation has recently been used for curative treatment of atrial fibrillation. METHODS AND RESULTS: Three of 239 patients who underwent ablation close to the pulmonary vein (PV) ostia at our institute developed severe hemoptysis, dyspnea, and pneumonia as early as 1 week and as late as 6 months after the ablation. Because the patients were arrhythmia-free, the treating physician initially attributed the symptoms to new-onset pulmonary disease (e.g., bronchopulmonary neoplasm). After absent PV flow was confirmed by transesophageal echocardiography, transseptal contrast injection depicted a totally occluded PV in all three patients. Successful recanalization, even in chronically occluded Pvs, was performed in all patients. During follow-up, Doppler flow measurements by transesophageal echocardiography demonstrated restenosis in all primarily dilated PV, which led to stent implantation. CONCLUSION: PV stenosis/occlusion after catheter ablation of atrial fibrillation occurs in a subset of patients. However, because in-stent restenosis occurred in two patients after 6 to 10 weeks, final interventional strategy for PV stenosis or occlusion remains unclear. To prevent future PV stenosis or occlusion, a decrease in target temperature and energy of radiofrequency current or the use of new energy sources (ultrasound, cryothermia, microwave) seems necessary.
Ernst et al. (Tue,) conducted a observational in Atrial fibrillation (n=239). Catheter ablation was evaluated on Total pulmonary vein occlusion. Catheter ablation for atrial fibrillation resulted in total pulmonary vein occlusion in 3 of 239 patients (1.3%), presenting with severe respiratory symptoms mimicking primary lung disease.