Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

Abstract

Background— Pulmonary vein stenosis has recently been recognized as a complication of radiofrequency ablation for atrial fibrillation. This study evaluates the presentation of affected patients and the role of transcatheter therapy for this patient population. Methods and Results— This study used a retrospective review of data from 19 patients (age, 51±13 years) with pulmonary vein stenosis who underwent catheterization and angiography between December 2000 and December 2002. Quantitative perfusion and spiral CT scans were performed for initial diagnosis and follow-up. The median duration between radiofrequency ablation and the reported onset of respiratory symptoms for 18 of 19 patients was 7.5 weeks (0.1 to 48). After the onset of symptoms, all but two patients were initially misdiagnosed with a symptoms-to-diagnosis duration of 16 weeks (2–59). At initial catheterization, 17 of 19 patients had angioplasty in 30 veins with stent placement in 5 vessels when a flap occurred. Overall vessel diameter increased from 2.6±1.6 to 6.6±2.4 mm ( P <0.0001). There were 4 procedure-related adverse events but no long-term sequelae. Immediate follow-up showed improved flow to involved lung segments. At a median follow-up of 43 weeks (2–92), although repeat angioplasty for restenosis was necessary in 8 of 17 patients, 15 of 17 patients currently have no or minimal persistent symptoms. Conclusions— Pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation is often misdiagnosed. Although further follow-up is necessary to determine long-term success, our data indicate better pulmonary vein flow and symptomatic improvement in the majority of patients undergoing dilation of postablation pulmonary vein stenosis.

Long‐term outcome of percutaneous intervention for pulmonary vein stenosis after pulmonary vein isolation procedure

“…4 Percutaneous intervention for PVS after PVI has been reported by several groups, all with relatively small numbers of patients and short to mid-term follow-up. [12][13][14][16][17][18] This study describes mid-to long-term outcomes of percutaneous intervention for the largest number of patients with PVS after PVI reported to date. It has been previously shown that for veins displaying close to normal or normal upstream diameter, stent implantation is superior to balloon dilation, with significantly higher re-intervention rates for the latter.…”

“…The catheterization procedure has been previously described in detail. 16 Pulmonary artery wedge angiography was performed to visualize the stenotic vein on levophase prior to transseptal puncture ( Figure 1). Very early in the experience, balloon angioplasty was always performed as the first intervention regardless of upstream diameter, but soon thereafter, primary stenting was performed in larger vessels.…”

“…4 Percutaneous intervention is the current treatment approach for this syndrome, with previous reports documenting good acute and mid-term outcomes, although highly dependent on pre-intervention pulmonary vein anatomy. [12][13][14][16][17][18] This report will describe longer term outcomes of percutaneous pulmonary vein intervention from a single institution over a 16-year period.…”

Pulmonary vein stenosis with collateralization via esophageal varices: Long-term follow-up after successful treatment with drug-eluting stent

“…6,7 An important point emphasized by this case is the discrepancy between the initial diagnosis provided by CT scan versus catheterization with conventional angiography: despite a CT scan suggesting LLPV atresia, angiography found that there was indeed pinhole patency of the LLPV, permitting catheter-based intervention. That pinhole patency of PVs can be missed by CT angiography has been previously described, 11 and highlights a number of advantages of conventional angiography over CT, such as higher spatial and temporal resolution, and the ability of pulmonary artery wedge angiography to force contrast through a pinhole PV ostium that might not be visible by…”

Repair of injured right inferior pulmonary vein during mitral valve replacement

“…Accidental total thrombosis of both pulmonary veins after ablation for AF may be misdiagnosed for 8-16 weeks [2,4]. The main symptoms of this complication such as shortness of breath, excertional dyspnea, and hypoxemia are usually attributed to the antecedent heart operation and/or to the pre-existent congestive heart failure.…”