Incidence of pulmonary vein stenosis after radiofrequency catheter ablation of atrial fibrillation

Abstract

Pulmonary vein (PV) stenosis is a well known complication of the early era of radiofrequency catheter ablation (RFCA) of atrial fibrillation. Its diagnosis has decreased over time and with technical improvement, but less is known about its true prevalence, because of non-specific symptoms and the need for dedicated PV imaging, which is usually not performed systematically after PV isolation. To evaluate the incidence of PV stenosis with current methods of RFCA. This was a retrospective, observational study of 387 patients who underwent RFCA of atrial fibrillation between 2012 and 2016. All patients had a computed tomography scanner of left atrium and pulmonary veins before and 3 months after the procedure. All underwent last generation 3-dimensional electroanatomic mapping to guide RFCA. Severe (≥ 70%) PV stenosis was detected in 12 patients (3.1%), and moderate (50–69%) occurred in 38 (9.8%). Twenty-eight patients developed one PV stenosis (7.2%) and 10 patients developed two or more PV stenosis (2.6%). The localization of the PV stenosis was in the left superior PV in 38% (19 PVs), in the left inferior PV in 28% (14 PVs, in the right superior PV in 16% (8 PVs) and in the right inferior PV in 16% (8 PVS). There were significantly more PV stenosis in the left PVs ( P = 0.006) but there was no statistical significant difference between the upper and lower veins ( P = 0.31). In this study the incidence of asymptomatic PV stenosis remains a frequent complication after radiofrequency ablation and raises the question of the indication of a routine scanner. A 3-month waiting period seems appropriate for the diagnosis of PV stenosis and subsequent discussion of optimal management, depending on symptoms but also on the severity of stenosis.