Pulmonary vein stenosis following catheter ablation of atrial fibrillation

Current Opinion in Cardiology

Volumn 20, Issue 6, 2005, Pages 484-490

  Pürerfellner, Helmut ^a   Martinek, Martin ^a  

^a Academic Teaching Hospital   (Austria)

Author keywords

Atrial fibrillation; Catheter ablation; Pulmonary vein stenosis

Indexed keywords

CATHETER ABLATION; COMPUTER ASSISTED TOMOGRAPHY; HEART ATRIUM FIBRILLATION; HEMODYNAMICS; HUMAN; INCIDENCE; LUNG SCINTISCANNING; NUCLEAR MAGNETIC RESONANCE IMAGING; PRIORITY JOURNAL; PULMONARY VEIN; PULMONARY VEIN OBSTRUCTION; REVIEW; STENT; SURGICAL TECHNIQUE; SYMPTOM; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; VEIN DILATATION;

ATRIAL FIBRILLATION; CATHETER ABLATION; CONSTRICTION, PATHOLOGIC; ECHOCARDIOGRAPHY, TRANSESOPHAGEAL; HUMANS; INCIDENCE; MAGNETIC RESONANCE IMAGING; POSTOPERATIVE COMPLICATIONS; PULMONARY VEINS; TOMOGRAPHY, X-RAY COMPUTED;

EID: 27644543081     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.hco.0000179816.80576.3c     Document Type: Review

References (29)

1. Kato R, Lickfett L, Meininger G, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation. Circulation 2003; 107:2004-2010.
2. Marom EM, Herndon JE, Kim YH, et al. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology 2004; 230:824-829. A contrast-enhanced CT study in a larger number of patients (most of them without atrial fibrillation) to classify the various pulmonary venous drainage patterns. Right-sided venous drainage was more variable than left-sided venous drainage.
3. Chen SA, Hsieh MH, Tai CT, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 1999; 100:1879-1886.
4. Haissaguerre M, Jais P, Shah DC, et al. Electrophysiological endpoint for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000; 101:1409-1417.
5. Saad EB, Rossillo A, Saad CP, et al. Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of ablation strategy. Circulation 2003; 108:3102-3107.
6. Pappone C, Oreto Q, Rosanio S, et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104:2539-2544.
7. Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 2005; 111:1100-1105. The largest survey on atrial fibrillation catheter ablation experience to date, including success rates and complications with different techniques over the years between 1995 and 2002.
8. Lemola K, Sneider M, Desjardins B, et al. Effects of left atrial ablation of atrial fibrillation on size of the left atrium and pulmonary veins. Heart Rhythm 2004; 1:576-581. Assessment of left atrial volume and pulmonary vein ostial size using CT scans with three-dimensional reconstruction to study the effects of left atrial circumferential ablation.
9. Vasamreddy CR, Dalal D, Eldadah Z, et al. Safety and efficacy of circumferential pulmonary vein catheter ablation of atrial fibrillation. Heart Rhythm 2005; 2:42-48. Single-center report on the outcome of left atrial circumferential ablation including recommendations on how to prevent pulmonary vein stenosis (which occurred in two patients) by avoiding figure-of-eight lesions.
10. Oral H, Scharf C, Chugh A, et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003; 108:2355-2360.
11. Karch MR, Zrenner B, Deisenhofer I, et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation 2005; 111:2875-2880. A randomized and well designed study comparing the safety and effectiveness of two ablation techniques demonstrating a lower rate of pulmonary vein stenosis but no superiority of circumferential ablation over segmental pulmonary vein isolation (which is in contrast to a previous report by Oral et al., see reference 10).
12. Pürerfellner H, Cihal R, Aichinger J, et al. Pulmonary vein stenosis by ostial irrigated-tip ablation: incidence, time course, and prediction. J Cardiovasc Electrophysiol 2003; 14:158-164.
13. Lustgarten DL, Keane D, Ruskin J. Cryothermal ablation: mechanisms of tissue injury and current experience in the treatment of tachyarrhythmias. Prog Cardiovasc Dis 1999; 41:481-498.
14. Wong T, Markides V, Peters NS, et al. Clinical usefulness of cryomapping for ablation of tachycardias involving perinodal tissue. J Interv Card Electrophysiol 2004; 10:153-158. A smaller series of patients reporting on the safety of cryomapping and cryoablation in the vicinity of the compact atrioventricular node.
15. Avitall B, Lafontaine D, Rozmus G, et al. The safety and efficacy of multiple consecutive cryo lesions in canine pulmonary veins-left atrial junction. Heart Rhythm 2004; 1:203-209. An experimental animal study demonstrating the feasibility and safety of a set of cryolesions isolating the pulmonary veins without creating pulmonary vein luminal narrowing.
16. Tse HF, Reek S, Timmermanns C, et al. Pulmonary vein isolation using transvenous catheter cryoablation for treatment of atrial fibrillation without risk of pulmonary vein stenosis. J Am Coll Cardiol 2003; 42:752-758.
17. Hoyt RH, Wood M, Daoud E, et al. Transvenous catheter cryoablation for treatment of atrial fibrillation: results of a feasibility study. Pacing Clin Electrophysiol 2005; 28:S78-S82. A multicenter US study reporting the feasibility of cryoablation for ablation of atrial fibrillation using a first-generation cryoablation catheter with limited maneuverability. No single pulmonary vein stenosis or other serious adverse events occurred. Success rates are comparable with those obtained by radiofrequency energy.
18. Wong T, Markides V, Peters NS, et al. Percutaneous isolation of multiple pulmonary veins using expandable circular cryoablation catheter. Pacing Clin Electrophysiol 2004; 27:551-554. Single-case experience with a new catheter design to isolate the pulmonary veins suggesting greater ease of use and shorter procedure times.
19. Jin Y, Ross DL, Thomas SP. Pulmonary vein stenosis and remodeling after electrical isolation for treatment of atrial fibrillation: short- and medium term follow up. Pacing Clin Electrophysiol 2004; 27:1362-1370. Single-center report on the time course of pulmonary vein luminal narrowing and remodeling (including both an increase as well as a resolution of pulmonary vein stenosis) assessed by direct pulmonary vein angiography in patients undergoing a redo pulmonary vein ablation procedure.
20. Lickfett L, Dickfeld T, Kato R, et al. Changes of pulmonary vein orifice size and location throughout the cardiac cycle: dynamic analysis using magnetic resonance cine imaging. J Cardiovasc Electrophysiol 2005; 16:582-588. Magnetic resonance cine imaging study on pulmonary vein dynamics in healthy volunteers assessing location changes of the pulmonary vein orifice, which are dependent on the cardiac cycle and may be substantial.
21. Kluge A, Dill T, Ekinci O, et al. Decreased pulmonary perfusion in pulmonary vein stenosis after radiofrequency ablation: assessment with dynamic magnetic resonance perfusion imaging. Chest 2004; 126:428-437. Dynamic MR perfusion imaging was used in an elegant study to assess the functional impact of pulmonary vein stenosis correlating results with single-photon emission CT perfusion and with MR angiography. A subgroup of patients who underwent pulmonary vein dilatation was analyzed both before and after angioplasty.
22. Berkowitsch A, Neumann T, Ekinci O, et al. A decrease in pulmonary vein diameter after radiofrequency ablation predicts the development of severe stenosis. Pacing Clin Electrophysiol 2005; 28:S83-S85. Reduction of the pulmonary vein diameter on the day after pulmonary vein ablation assessed by MR angiography was used to predict pulmonary vein stenosis. A reduction of more than 25% was a strong independent predictor of development of severe pulmonary vein luminal narrowing.
23. Jander N, Minners J, Arentz T, et al. Transesophageal echocardiography in comparison with magnetic resonance imaging in the diagnosis of pulmonary vein stenosis after radiofrequency ablation therapy. J Am Soc Echocardiogr 2005; 18:654-659. Transesophageal echocardiographic Doppler measurements were compared with MR imaging to diagnose pulmonary vein stenosis. Combining elevated peak velocity with pathologic flow patterns (turbulence, little flow variation) exhibited good correlation to MR scanning and thus reliably detected or excluded significant pulmonary vein stenosis.
24. Nanthakumar K, Mountz JM, Plumb VJ, et al. Functional assessment of pulmonary vein stenosis using radionuclide ventilation/perfusion imaging. Chest 2004; 126:645-651. A small but well described series of patients undergoing radionuclide ventilation/perfusion scanning and relating results to anatomic imaging (CT, direct pulmonary venography) and direct measurements of pulmonary vein-left atrium pressure to assess the functional impact of pulmonary vein luminal narrowing. Lung scanning may be a nearly optimal screening tool for pulmonary vein stenosis and is very useful in assessing the hemodynamic consequence of an anatomic pulmonary vein stenosis.
25. Pürerfellner H, Aichinger J, Martinek M, et al. Incidence, management, and outcome in significant pulmonary vein stenosis complicating ablation for atrial fibrillation. Am J Cardiol 2004; 93:1428-1431. A single-center experience in the management of pulmonary vein stenosis demonstrating symptomatic improvement over a mid-term follow-up in patients with single-vessel disease even with documented restenosis after initial pulmonary vein dilatation/stenting.
26. Qureshi AM, Prieto LR, Latson LA, et al. Transcatheter angioplasty for acquired pulmonary vein stenosis after radiofrequency ablation. Circulation 2003; 108:1336-1342.
27. Packer DL, Keelan P, Munger TM, et al. Clinical presentation, investigation and management of pulmonary vein stenosis complicating ablation for atrial fibrillation. Circulation 2005; 111:546-554. The largest interventional single-center series from the Mayo Clinic on diagnosis and treatment of pulmonary vein stenosis, with the longest follow-up published to date. Despite the fact that percutaneous procedures produce rapid and dramatic symptom relief in patients with highly symptomatic pulmonary vein stenosis, the problem of restenosis remains substantial and unresolved.
28. Arentz T, Weber R, Jander N, et al. Pulmonary hemodynamics at rest and during exercise in patients with significant pulmonary veins stenosis after radiofrequency catheter ablation for drug resistant atrial fibrillation. Eur Heart J 2005; 26:1410-1414. First report on invasive hemodynamic monitoring using right-sided heart catheterization to assess pulmonary hemodynamics during rest and exercise in the long-term follow-up of patients with significant and asymptomatic or mildly symptomatic pulmonary vein stenosis left untreated. Although no patient had pulmonary hypertension at rest, some patients revealed elevated right-sided heart pressures during exercise. All patients with multivessel disease were affected.
29. Taylor GW, Kay GN, Zheng X, et al. Pathological effects of extensive radiofrequency energy applications in the pulmonary veins in dogs. Circulation 2000; 101:1736-1742.