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Pulmonary Vein Stenosis Complicating Catheter Ablation of Focal Atrial Fibrillation
Author(s) -
SCANAVACCA MAURICIO I.,
KAJITA LUIZ J.,
VIEIRA MARCELO,
SOSA EDUARDO A.
Publication year - 2000
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2000.tb00030.x
Subject(s) - medicine , pulmonary vein stenosis , atrial fibrillation , pulmonary vein , radiofrequency ablation , cardiology , left pulmonary vein , ostium , catheter ablation , catheter , stenosis , coronary sinus , ablation , radiology , surgery
Pulmonary Vein Stenosis. Introduction: A recently described focal origin of atrial fibrillation, mainly inside pulmonary veins, is creating new perspectives for radiofrequency catheter ablation. However, pulmonary venous stenosis may occur with uncertain clinical consequences. This report describes a veno‐occlusive syndrome secondary to left pulmonary vein stenosis after radiofrequency catheter ablation. Methods and Results: A 36‐year‐old man who experienced daily episodes of atrial fibrillation that was refractory to antiarrhythmic medication, including amiodarone, was enrolled in our focal atrial fibrillation radiofrequency catheter ablation protocol. The left superior pulmonary vein was the earliest site mapped, and radiofrequency ablation was performed. Atrial fibrillation was interrupted and sinus rhythm restored after one radiofrequency pulse inside the left superior pulmonary vein. Atrial fibrillation recurred and a new procedure was performed in an attempt to isolate (26 radiofrequency pulses around the ostium) the left superior pulmonary vein. Ten days later, the patient developed chest pain and hemoptysis related to severe left superior and inferior pulmonary veins stenosis. Balloon angioplasty of both veins was followed by complete relief of symptoms after 2 months of recurrent pulmonary symptoms. The patient has been asymptomatic for 12 months, without antiarrhythmic drugs. Conclusion: Multiple radiofrequency pulses applied inside the pulmonary veins ostia can induce severe pulmonary venous stenosis and veno‐occlusive pulmonary syndrome.