Pulmonary vein stenosis and remodeling after electrical isolation for treatment of atrial fibrillation: short- and medium-term follow-up

Abstract

Asymptomatic pulmonary vein (PV) stenosis after PV electrical isolation for atrial fibrillation has been reported in several studies and may be due to dynamic factors. The purpose of this study was to determine if PV stenosis progresses after the initial procedure. Consecutive patients (n = 26) requiring repeat procedures for atrial fibrillation recurrence were studied (mean age 55 +/- 12 years). Segmental PV potential-guided ostial ablation was performed with transvenous catheters. Biplane angiographic images were obtained before and after each procedure (52 procedures). Stenoses were found in 14 (16%) of 87 targeted veins immediately after the initial procedures. After 129 +/- 94 days no new stenoses were found at the second procedure. PV stenoses were unchanged in 8 previously stenosed veins, slightly deteriorated in 1 vein, improved in 2 veins, and fully resolved in 3 veins. No patients had symptoms attributable to PV stenosis. PV stenosis occurred in 6 (9%) of 68 additional veins at the second procedure. No baseline or procedural characteristics predicted stenosis. Progression of PV stenosis is uncommon in the medium term. Complete or partial resolution of PV stenosis occurs in approximately one third of cases. Absence of PV stenosis after an initial procedure does not ensure PV stenosis will not occur with further ablation in the same vein.