Pulmonary vein stenosis after pulmonary vein isolation using duty-cycled unipolar/bipolar radiofrequency ablation guided by intracardiac echocardiography.

Abstract

Concerning rates of pulmonary vein (PV) stenosis were reported following PV isolation (PVI) with a circular pulmonary vein ablation catheter (PVAC). As this may depend on intraprocedural imaging, we evaluated the incidence of PV stenosis in patients undergoing PVAC-PVI with continuous surveillance by intracardiac echocardiography (ICE). Multi-slice computed tomography was performed before and 3 months after PVAC-PVI with continuous ICE surveillance in 30 patients (37 % male, 65 ± 9 years). PV areas at two levels (ostial and 1 cm distally) and left atrial (LA) volumes were measured. PV area/LA volume ratio was calculated to correct for reverse LA remodelling. PV stenosis was classified as mild (25-50 %), moderate (50-75 %) and severe (> 75 %). One hundred sixteen veins were isolated with PVAC with additional touch-up ablation in one patient. One patient was excluded from analysis for untriggered CT acquisition. Left atrial volume decreased from 109.1 ± 30.9 cm(3) before to 98.4 ± 34.4 cm(3) after ablation (p < 0.05). Overall, PV areas decreased ostially from 209.0 ± 80.3 mm(2) to 171.2 ± 74.6 mm(2) (p < 0.0001) and distally from 155.2 ± 61.5 mm(2) to 141.0 ± 51.3 mm(2) (p < 0.0001). After adjustment for LA volume reduction, PV area significantly reduced only at the ostial level (p = 0.0069). Mild PV stenosis (ostial/distal) was detected in 17/9 PVs (14.7 %/7.8 %) and moderate PV stenosis in 7/0 PVs (6.0 %/0 %). PV stenosis occurred more often in superior PVs (p = 0.0004). No severe PV stenosis occurred. All patients remained asymptomatic. While the use of ICE does not fully prevent the occurrence of ostial PV stenosis after PVAC-PVI, no significant narrowing in distal PVs was observed. Superior PVs are prone to PV stenosis after PVAC-PVI.