The incidence, diagnosis, and management of pulmonary vein stenosis as a complication of atrial fibrillation ablation

Abstract

Recent peer-reviewed articles suggest that PVI carries a 3-8% risk of developing PVS, but they likely underestimate the incidence of PVS, as specific screening and diagnostic guidelines are not established. Imaging modalities should be used to screen patients after ablation of AF since early recognition of PVS improves treatment outcomes. Treatment with angioplasty and stent placement can improve symptoms and lung perfusion but the benefit of treatment with immediate stent placement remains controversial. It is critical to maintain a high clinical index of suspicion for PVS in at-risk individuals to ensure timely detection and treatment.

Pulmonary vein stenosis complicating radiofrequency catheter ablation for atrial fibrillation: A literature review

“…41 Symptoms related to PVS typically occur with a reduction in lung perfusion by 20-25%. 19 Kluge also reported that PVS causes decreased perfusion identified by magnetic resonance perfusion imaging and that this perfusion improved after venoplasty. 48 Changes in the pulmonary blood distribution based on the presence of abnormal V/Q scans were reported by Saad,et al 7 Backflow resistance due to pulmonary veins obstruction results in increased pulmonary capillary pressure, which could lead to pulmonary hypertension.…”

“…3, 18 Rostamian recently reviewed 41 publications to determine the incidence of PVS and changes in incidence over time. 19 Since 2004 the mean incidence of PVS has been 2% and the median incidence has been 3.1% in published studies. These rates are lower than the incidence rates reported between 1999 and 2004.…”

“…Therefore, the development of PVS has decreased with accurate and precise positioning of the catheter during the RF application, frequent checking by fluoroscopy, the use of intracardiac echocardiography, and the use of 3-dimensional mapping systems. 3,19 However, stenosis can still develop even with current technology, including the use of continuous surveillance with intracardiac echocardiography. 20 Cryoballoon ablation was developed to provide a safer alternative for pulmonary vein isolation.…”

Pulmonary veins stenosis relief after an inappropriate radiofrequency catheter ablation of atrial fibrillation in a young non-competitive athlete

“…Balloon venoplasty alone or with stent implanting is the principal treatment of pulmonary veins narrowing. It should be performed early, since late restoration of venous patency may not determine adequate perfusion of affected lungs segments, because of progressive periadventitial fibrosis and chronic vasoconstrinction of pulmonary vascular bed [5]. The rate of restenosis is quite high (up to 87%) with balloon venoplasty alone, while is relatively lower after stenting (up to 57%) [5].…”

“…It should be performed early, since late restoration of venous patency may not determine adequate perfusion of affected lungs segments, because of progressive periadventitial fibrosis and chronic vasoconstrinction of pulmonary vascular bed [5]. The rate of restenosis is quite high (up to 87%) with balloon venoplasty alone, while is relatively lower after stenting (up to 57%) [5]. A novel approach consists in implanting drug eluting stents with initial promising results obtained in a little number of patients [6].…”