Pulmonary vein total occlusion following catheter ablation for atrial fibrillation - Clinical implications after long-term follow-up

OBJECTIVES We present the clinical course and management outcomes of patients with total pulmonary vein occlusion (PVO). BACKGROUND Pulmonary vein occlusion is a rare complication that can develop after radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). The long term follow-up data of patients diagnosed with PVO are minimal. METHODS Data from 18 patients with complete occlusion of at least one pulmonary vein (PV) were prospectively collected. All patients underwent RFA for AF using different strategies between September 1999 and May 2004. Pulmonary vein occlusion was diagnosed using computed tomography (CT) and later confirmed by angiography when intervention was warranted. Lung perfusion scans were performed on all patients before and after intervention. The percent stenoses of the veins draining each independent lung were added together to yield an average cumulative stenosis of the vascular cross-sectional area draining the affected lung (cumulative stenosis index [CST]). RESULTS The patients' symptoms had a positive correlation with the CST (r = 0.843, p < 0.05) and a negative one with the lung perfusion (r = -0.667, p < 0.05). A CST >= 75% correlated wen with low lung perfusion (< 25%; r = -0.854, p < 0.01). Patients with a CST >= 75% appeared to improve mostly when early (r = -0.497) and repeated dilation/stenting (r 0.0765) were performed. CONCLUSIONS Patients with single PVO are mostly asymptomatic and should undergo routine imaging. On the other hand, patients with concomitant ipsilateral PV stenosis/PVO and a CST >= 75% require early and, when necessary, repeated pulmonary interventions for restoration of pulmonary flow and prevention of associated lung disease.