Pulmonary Vein Stenosis after Radiofrequency Ablation for Atrial Fibrillation: Two Cases Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

1. Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China;
2. ;

Corresponding?author：

Keywords：

Pulmonary vein stenosis; Atrial fibrillation; Radiofrequency ablation; Clinical features

DOI：

10.7507/1671-6205.2016061

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Objective To analyze the clinical presentations and radiological characteristics of pulmonary vein stenosis after radiofrequency ablation. Methods Clinical and radiological data of 2 patients with pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. Results Both patients had undergone circumferential pulmonary vein isolation. The symptoms appeared approximately 2 months after the operation. The major symptoms were cough, hemoptysis, exacerbation of dyspnea and chest pain. Both patients were misdiagnosed as other diseases such as pneumonia in other hospitals, and the anti-infection therapy was invalid. Both CT scans showed parenchymal exudative consolidation with varying degrees of interstitial septal thickening and small nodules. Both patients were confirmed as pulmonary vein stenosis by CT angiography. Literature review identified 21 cases of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. The main clinical features are hemoptysis, chest pain, shortness of breath and cough. The most common features of thoracic radiological imaging are consolidation, groud-glass attenuation, pleural effusion and interstitial septal thickening. Conclusions If a patient presents with hemoptysis, dyspnea, chest pain or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation with interstitial septal thickening and multiple small nodules, the possibility of pulmonary vein stenosis should be considered. Contrast-enhanced CT combined with pulmonary vein imaging technology can clearly show the opening diameter of each pulmonary vein and its branches, so it is an important non-invasive examination method for the evaluation and diagnosis of pulmonary vein stenosis.

Citation： Yu Min, Li Yan, Miao Liyun, Ma Miao, Zhu Bin, Wang Maoxue, Cai Hourong. Pulmonary Vein Stenosis after Radiofrequency Ablation for Atrial Fibrillation: Two Cases Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(3): 261-265. doi: 10.7507/1671-6205.2016061 Copy

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6.	Pürerfellner H, Aichinger J, Martinek M, et al. Incidence, management, and outcome in significant pulmonary vein stenosis complicating ablation for atrial fibrillation. Am J Cardiol, 2004, 93:1428-1431.
7.	吳鋼, 黃從新, 江洪.射頻消融致肺靜脈狹窄的病理特征.中華心血管病雜志, 2004, 32:539-540.
8.	Rostamian A, Narayan SM, Thomson L, et al. The incidence, diagnosis, and management of pulmonary vein stenosis as a complication of arial fibrillation ablation. J Interv Card Electrophysiol, 2014, 40:63-74.
9.	De Potter TJ, Schmidt B, Chun KR, et al. Drug-eluting stents for the treatment of pulmonary vein stenosis after atrial fibrillation ablation. Europace, 2011, 13:57-61.
10.	楊延宗, 王照謙, 王鳴遒, 等.多層螺旋CT在評價心房顫動導管射頻消融電隔離術后肺靜脈狹窄中的應用.中華心血管病雜志, 2004, 32:217-220.
11.	Ravenel JG, McAdams HP. Pulmonary venous infarction after radiofrequency ablation for atrial fibrillation. Am J Roentgenol, 2002, 178:664-666.
12.	王建德, 李建蓉.肺靜脈狹窄的診治及進展.中華醫學超聲雜志(電子版), 2010, 7:1560-1565.

1. 劉潔, 莊少俠, 陸國礎, 等.房顫導管消融致遲發性肺靜脈狹窄一例.中華結核和呼吸雜志, 2015, 38:309-310.
2. 羅學勝, 張紅, 劉建民, 等.心房顫動患者射頻消融術后肺靜脈狹窄誤診分析.臨床誤診誤治, 2012, 25:62-64.
3. Chen SA, Hsieh MH, Tai CT, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation, 1999, 100:1879-1886.
4. Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation, 2005, 111:1100-1105.
5. Packer DL, Keelan P, Munger TM, et al. Clinical presentation, investigation, and management of pulmonary vein stenosis complicating ablation for atrial fibrillation. Circulation, 2005, 111:546-554.
6. Pürerfellner H, Aichinger J, Martinek M, et al. Incidence, management, and outcome in significant pulmonary vein stenosis complicating ablation for atrial fibrillation. Am J Cardiol, 2004, 93:1428-1431.
7. 吳鋼, 黃從新, 江洪.射頻消融致肺靜脈狹窄的病理特征.中華心血管病雜志, 2004, 32:539-540.
8. Rostamian A, Narayan SM, Thomson L, et al. The incidence, diagnosis, and management of pulmonary vein stenosis as a complication of arial fibrillation ablation. J Interv Card Electrophysiol, 2014, 40:63-74.
9. De Potter TJ, Schmidt B, Chun KR, et al. Drug-eluting stents for the treatment of pulmonary vein stenosis after atrial fibrillation ablation. Europace, 2011, 13:57-61.
10. 楊延宗, 王照謙, 王鳴遒, 等.多層螺旋CT在評價心房顫動導管射頻消融電隔離術后肺靜脈狹窄中的應用.中華心血管病雜志, 2004, 32:217-220.
11. Ravenel JG, McAdams HP. Pulmonary venous infarction after radiofrequency ablation for atrial fibrillation. Am J Roentgenol, 2002, 178:664-666.
12. 王建德, 李建蓉.肺靜脈狹窄的診治及進展.中華醫學超聲雜志(電子版), 2010, 7:1560-1565.

Chinese Journal of Respiratory and Critical Care Medicine

Pulmonary Vein Stenosis after Radiofrequency Ablation for Atrial Fibrillation: Two Cases Report and Literature Review

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