Acquired pulmonary vein stenosis after radiofrequency ablation treated by angioplasty and stent implantation

OBJECTIVE: Pulmonary vein (PV) stenosis is a late complication of radiofrequency ablation for atrial fibrillation. Although frequently asymptomatic, it can be associated with severe respiratory symptoms that cause significant morbidity. This study evaluated the role of angioplasty and stent implantation in patients affected by acquired PV stenosis. METHODS: Between June 2003 and June 2004, six patients with seven acquired iatrogenic PV stenoses, documented by multislice computed tomography scanning, underwent catheterisation and angiography at the St. Ambrogio Clinical Institute, Milan, Italy. RESULTS: The median duration between radiofrequency ablation and the reported onset of respiratory symptoms was 13.5 months (interquartile range 6.7-22.2 months). All of patients were symptomatic (New York Heart Association functional class II or III). Five PV stenoses were treated by angioplasty and stent implantation. In one patient, the procedure was not performed because of endoluminal thrombosis and in another one recanalisation of occluded PV was unsuccessful. At angiography overall vessel diameter increased from 1.7 ± 0.5 to 8.2 ± 0.8 mm (P < 0.05). There were no procedure-related major adverse events. Immediate follow-up by multislice computed tomography scanning showed patency of the PV. At a median follow-up of 17.1 months (interquartile range 10.6-22.2 months), all patients have no or minimal persistent symptoms; multislice computed tomography showed patency of the PV followed at a median time of 16.4 months (interquartile range 10.3-22.3 months). CONCLUSIONS: The treatment of PV stenosis by angioplasty with stent implantation is feasible and safe. The majority of patients undergoing this procedure showed symptomatic improvement and patency of the PV.