Introduction: Radiofrequency catheter ablation (RFCA), an effective treatment for atrial fibrillation (AF), is rarely complicated by severe pulmonary vein stenosis (PVS) requiring intervention. We sought to evaluate the safety of repeat RFCA in AF patients with moderate PVS after index RFCA.
Hypothesis: We hypothesized, in patients with moderate PVS, repeat RFCA would not result in significant progression of PVS.
Methods: We performed a retrospective, observational study of all patients who developed moderate PVS (decrease in the PV cross sectional area ≥50% but <75%) after index RFCA for AF. RFCA was performed with standard techniques for pulmonary vein antral isolation. All patients underwent CT scan of the heart with contrast prior to their first ablation and 3 months after each ablation procedure. Additional CT scans were completed per provider discretion in follow-up.
Results: Of a total of 2550 AF patients who underwent RFCA from 2011-2016, 165 (6.4%) developed moderate PVS of at least one PV. Mean age was 65 ± 11 years, with 130 (79%) males and 113 (68%) with paroxysmal AF. Right superior, right inferior, left superior and left inferior PVs were involved in 31%, 29%, 41%, and 20% of patients, respectively. Of these 165 patients, 78 (47%) underwent repeat CT scan (with or without redo ablation), and 48 (29%) underwent redo RFCA in the antrum of the involved PV. Mean times between CT1-CT2 and CT2-CT3 were 6 and 11 months, respectively. On repeat CT, 6 (8%) developed severe PVS of at least one PV. There was no statistical difference in the incidence of severe PV stenosis between those who underwent repeat ablation compared to those who did not (4.2 vs. 14.3 respectively; p = 0.185)
Conclusions: Repeat RFCA for AF in patients with prior moderate PV stenosis appears to be safe with an acceptable risk (4.2%) of developing severe PV stenosis.