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European Heart Journal Advance Access published online on April 26, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi279
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received January 6, 2005
Revised March 7, 2005
Accepted March 18, 2005

Clinical research

Pulmonary haemodynamics at rest and during exercise in patients with significant pulmonary vein stenosis after radiofrequency catheter ablation for drug resistant atrial fibrillation

Thomas Arentz 1*, Reinhold Weber 1, Nikolaus Jander 1, Gerd Bürkle 1, Jörg von Rosenthal 1, Thomas Blum 1, Jochem Stockinger 1, Laurent Haegeli 1, Franz Josef Neumann 1, and Dietrich Kalusche 1

1 Abteilung Rhythmologie, Herz-Zentrum, Südring 15, 79188 Bad Krozingen, Germany

* To whom correspondence should be addressed.
Thomas Arentz, E-mail: thomas.arentz{at}herzzentrum.de


  Abstract

Aims Iatrogenic pulmonary vein (PV) stenosis after radiofrequency catheter ablation for atrial fibrillation (AF) is a new pathology in cardiology. The effects of PV stenosis on the pulmonary circulation are not yet known. We provide long-term follow-up data in patients with significant PV stenosis including magnetic resonance imaging (MRI) and Swan Ganz (SG) right heart catheterization.

Methods and results One hundred and seventeen patients had MRI 12-24 months after the AF ablation procedure. Eleven patients (58 ± 7 years, nine males) with significant stenosis (n = 9) or occlusion of the proximal PV (n = 5) at this follow-up were re-examined using MRI and SG right heart catheterization at rest and during exercise (follow-up time since PV ablation 50 ± 15 months). None of these underwent previous PV angioplasty. When compared with prior MRI studies, no significant changes were noted. At rest, no patient had pulmonary hypertension. At 100 W, seven patients had elevated pulmonary artery pressures, three of them probably caused, in part, by left ventricular dysfunction.

Conclusion Significant stenosis/occlusions of one or two PV do not create pulmonary hypertension at rest during long-term follow-up. However, seven of the 11 patients develop pulmonary hypertension during exercise. All three patients with stenosis/occlusions of two PV were affected.

Keywords: Atrial fibrillation; Pulmonary veins; Stenosis; Ablation; Pulmonary hypertension.
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